Relying on repeal. Most Republican "alternatives" automatically repeal the Affordable Care Act, which automatically removes coverage for more 9.5 million Americans who've been insured under the ACA, as well those insured through the Medicaid expansion.
Messing with Medicaid. The GOP "alternatives" to the ACA impose a per capita cap on Medicaid, essentially turning it into a block grant and forcing states to cover fewer people. Some limit it to the disabled, pregnant women, children, and families below the poverty line. Childless people are excluded. The working poor are forced back into the private insurance market.
Raising taxes on workers. The Senate GOP "alternative" removes the tax exclusion for employer-provided health plans, and replaces it with a 65 percent "cap" that would require workers to pay taxes on 35 percent of their health benefits. For a family of four, that's about $1,300 per year. It's a tax increase for 150 million American workers and their families.
Turning subsidies into tax credits. The GOP "alternatives" rely on modest tax credits that Americans will use to buy private insurance. There are no minimum requirements on coverage, so that skimpy coverage will be all some can afford. The Senate bill sets up a flat subsidy that's guaranteed to shrink in value, because it increases with age instead of need. It cuts off premium subsidies at 300 percent of the poverty line, leaving millions without the financial help provided by the ACA.
Turning back time on pre-existing conditions. Most of the "alternatives" allow insurance companies to discriminate against people with pre-existing conditions. (The Senate bill makes an exception for those who maintain "continuous coverage," but a gap in coverage means you're on your own.) High-risk pools existed in 35 states before Obamacare, and they were underfunded and un-inclusive. Premiums were twice the market rate, and as much as 25 percent of household income. Most had long waiting periods before covering a pre-existing condition. Due to enrollment restrictions, not everyone denied insurance in the private market was eligible for their state's high risk pool.
Raising rates for women and seniors. The GOP "alternatives" do away with a lot of ACA regulations designed to protect consumers. "Gender rating" allowed insurers to consider gender when setting premiums. Mothballed by Obamacare, it's back in the GOP "alternatives," ushering in a return to the days when women paid $1 billion more for insurance than men. "Age rating" is back too, so insurance companies could charge a 64-year-old five times as much as a 24-year-old, while Obamacare limits it to three times as much.
Erasing state lines. Conservatives have long loved the idea of letting insurance companies sell across state lines, and it shows in their alternatives. When the Supreme Court ruled that credit card companies could "export" their home states' interest caps, companies moved to the states with low-to-no interest caps. It took Congress 31 years to do something about it. The GOP wants to give insurance companies the same "Get Out of Regulations Free" card.
Locking the courthouse door. All the GOP "alternatives" include "tort reform," which limits the amount of money injured people can receive in a malpractice lawsuit. Conservatives cite excessive "frivolous lawsuits" as a major cause of rising health care costs. Studies of malpractice lawsuits found that only four to seven percent of those injured ever file lawsuits. In states like Texas and Ohio, tort reform failed to cut health care costs.
Saving up for health care. Health care savings accounts would allow people to deposit pre-tax funds into accounts to pay for medical costs. George W. Bush started promoting them in 2006. Health care savings accounts, by definition favor the well and the wealthy. Those who don't have a lot of money to save in the first place, who can't use tax breaks, have big medical bills, and can't afford insurance premiums are no better off.