House Republican Budget Plan Hazy on Health Details

House Republicans are hoping they can pass a 2019 budget designed for a world where the Affordable Care Act is gone, and where the traditional Medicare program looks more like the Medicare Advantage program.

They have started out by posting a draft 2019 budget proposal that gives only general descriptions about how to get from here to there.

Rep. Steve Womack, R-Ark., the chairman of the House Budget Committee, posted the proposal on the committee’s website today.

Links to information about the budget proposal — including the full text of the proposal, a long description, and a one-page summary — are available here.

(Related: Trump’s Request to Cancel Spending Has Shot at Passing Congress)

Fiscal year 2019 starts Oct. 1.

Drafters of the new fiscal year 2019 budget proposal discuss the future of the Affordable Care Act, briefly, in the long description of the proposal, “A Brighter American Future: A Balanced Budget for FY 2019.”

“Reflecting the long-held conservative consensus in the House, this budget assumes Congress repeals Obamacare and replaces it with a patient-centered, free-market health care system,” the drafters say.

The authors sketch out their views on the future of Medicare in the full-text version of the proposal, in a section with the title “Policy on Medicare Reform.”

There, the authors of the proposal say they assume that:

• In the future, Medicare enrollees will get to compete from competing guaranteed managed care plan coverage options.
• Traditional fee-for-service Medicare will remain a plan option.
• Medicare will provide more help for lower-income enrollees, and those with more health problems.

The drafters imply that the government would limit subsidies for Medicare enrollees through a “premium support model,” and reshape the traditional Medicare program to make it look more like the Medicare Advantage program.

In a premium support system, the enrollees choose from a menu of plans that may have different prices. The federal government shares part of the cost of the premiums, without necessarily compensating for all of the menu option cost variations, according to a Congressional Budget Office document cited in the budget description document.

In the new premium support system included in the new budget proposal, “private plans providing the same level of health coverage would compete for seniors’ business, just as Medicare Advantage does today,” the authors say. “By adopting a competitive structure, the program would also deliver savings for seniors in the form of lower monthly premium costs. Today, only Medicare Advantage offers seniors the opportunity to choose from a selection of comprehensive coverage plans.”

In a section on Medicaid, the drafters say they believe that states should encourage state Medicaid programs to adopt requirements for ”able-bodied, non-elderly, non-pregnant adults without dependents to work, actively seek work, participate in a job-training program, or do community service, in order to receive Medicaid.”

The drafters suggest that a typical state’s Medicaid work requirement could include 30 hours per week of work, and 20 hours devoted to activities such as working, getting job training and looking for work.

The proposal does not appear to include major proposals related to retirement plans, pension plans for private-sector workers, the estate tax, the gift tax, life insurance or annuities.

— Read Trump’s 2018 Budget Makes Room for ACA Programs, on ThinkAdvisor.

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