Comparing the Republican ObamaCare Replacement Plans – Part V


There is another plan for replacement of ObamaCare that deserves consideration. This fifth plan is the work of Avik Roy, a well-respected healthcare economist of the Manhattan Institute.

The Exchange Plan

Originally called Transcending ObamaCare: A Patient-Centered Plan for Near-Universal Coverage and Permanent Fiscal Solvency, the plan has been renamed simply The Exchange Plan. It seeks to copy portions of the most successful healthcare systems in the world, especially Switzerland and Singapore. These countries spend a small fraction of what we do on healthcare yet deliver universal coverage with high levels of quality and access.

Five Goals

The stated goals of The Exchange Plan include the following:

  • Expand coverage well above ObamaCare levels –without the individual mandate
  • Improve the quality of coverage and care for low-income Americans
  • Permanent solvency of all U.S. healthcare entitlements
  • Reduce the federal deficit without raising taxes
  • Reduce the cost of health insurance

Roy believes his plan will achieve all of these lofty goals.

Five Core Elements

  • Exchange reform. Repeal the Individual Mandate that requires all Americans to purchase health insurance. Restore the primacy of state-based exchanges and insurance regulation. Expand the flexibility of insurers to design insurance policies more attractive to consumers by providing higher quality at lower cost (eliminate the “essential health benefits”). Expand Health Savings Accounts. With these exchange reforms, coverage will expand despite the absence of an individual mandate.
  • Employer-sponsored insurance reform. Repeal the Employer Mandate. Give employers more options for providing employee coverage. Preserve the “Cadillac Tax” to discourage high-cost plans but repeal other taxes and reform regulations that artificially drive up the cost of employer-based insurance.
  • Medicaid reform. Migrate the Medicaid acute care population onto the reformed state-based exchanges with 100% federal funding and state oversight. In exchange, the plan returns to the states, over time, full financial responsibility for the Medicaid long-term care
  • Medicare reform. The Medicare eligibility age gradually rises by four months each year. The end result is to preserve Medicare for current retirees, and to maintain future retirees on their exchange–based or employer-based insurance until they are Medicare eligible. These changes would make the Medicare Trust Fund permanently solvent.
  • Other reforms. The plan also tackles issues like hospital monopolies that drive up prices, malpractice litigation in federal programs, and the pace of medical innovation by reform of the FDA.


Scoring the Plan

The plan was internally scored by including a model developed by the Health Systems Innovation Network and data projections from the Congressional Budget Office and the Centers for Medicare and Medicaid Services.

Cost of Coverage

The plan is expected to reduce the average cost of commercial insurance premiums by 17% for singles and 4% for families.

Coverage Impact

The plan is expected to increase coverage to 12.1 million more Americans when compared to ObamaCare.

Access to Providers

Using the Patient to Provider Access Index developed at The University of Minnesota, the plan is expected to increase average provider access by 4 percent. Those individuals who migrate from traditional Medicaid to the reformed exchanges will see an increase in provider access of 98 percent.

Medical Productivity Improvement

Overall, the entire non-elderly population, relative to ObamaCare, will see an increase average healthcare outcome improvement of 21 percent. For those individuals who migrate from traditional Medicaid to the reformed exchanges, they will see a dramatic improvement in healthcare outcomes of 159 percent.

Federal Deficit Impact

The plan is estimated to reduce federal spending by $283 Billion and federal revenues by $254 Billion, for a net deficit reduction of $29 Billion in the first ten years. However, over the first 30 years, the plan will result in a net deficit reduction of approximately $8 Trillion. The plan will also result in permanent solvency of the Medicare Trust Fund.

Comparison of Plans

An important feature of The Exchange Plan, and the Sessions-Cassidy Plan, is the Medicaid reform that will lift millions of Americans off this second-class healthcare and give them first-class healthcare for the first time. Instead of coverage on paper only, these Americans will actually have improved access to providers and improved healthcare outcomes – in other words, real healthcare insurance!

These two plans should get serious consideration because they both go a long way toward solving the real problems of ObamaCare. They both increase coverage dramatically and both reduce the number of Americans on Medicaid, converting these people to private healthcare insurance. These two important features should be welcomed by both Republicans and Democrats alike who are seriously concerned with providing the best quality healthcare to the most Americans at the lowest cost.

One comment

  1. I really would love to read Dr. Roberts books. Great doctor and professional. We really need people like him in our country and society. God bless him.

    Comment by Jeannette on February 2, 2017 at 11:16 pm