More than five years after taking the majority on a promise to replace the 2010 Affordable Care Act, House Republicans have elected again not to advance a comprehensive alternative.
Instead, lawmakers are putting forward a general outline Wednesday that combines a series of familiar conservative healthcare ideas, including overhauling the government's Medicare and Medicaid programs and eliminating federal regulations that require insurance plans to cover a basic set of benefits.
The 37-page plan, promised since Rep. Paul D. Ryan (R-Wis.) became House speaker last year, was originally billed as part of a comprehensive governing blueprint that would show voters the GOP was ready to advance real alternatives to
"This isn't a return to the pre-Obamacare status quo," the new healthcare outline says. "And it isn't just an attempt to replace Obamacare and leave it at that. This is a new approach. It's a step-by-step plan to give every American access to quality, affordable health care."
In a speech Wednesday at the American Enterprise Institute in Washington, Ryan said the key difference between the GOP plan and the existing law is that "Obamacare focused on quantity," the number of people covered by insurance, while "our plan will focus on quality."
"More people have insurance now than before the law was passed, that's true," Ryan said, but that increase has come at too high a cost.
But like many previous Republican healthcare proposals -- including those put forward by presumptive GOP presidential nominee Donald Trump -- Ryan's latest blueprint is missing key details and legislative language that would allow independent analysts such as the Congressional Budget Office to assess its cost and impact.
Rather than showcasing the party's seriousness about policy, Ryan's plan may reinforce widespread skepticism about the GOP's interest in tackling complex healthcare policy.
Indeed, the new plan falls well short of what House Republicans themselves resolved to do more than five years ago, after they retook control of the House during the 2010 midterm election.
In January 2011, just days after the new Congress convened, GOP lawmakers unanimously backed a 12-point resolution that directed House committees to develop "legislation proposing changes to the existing law."
Among the things the legislation was supposed to do were lower health insurance premiums, preserve patients' ability to keep their doctors, provide access to affordable coverage for people with preexisting medical conditions and "increase the number of insured Americans."
No such bills were ever advanced out of a congressional committee.
In the new plan, House Republicans are again proposing to replace the current government-run Medicare benefit with a system of vouchers that seniors could use to offset at least part of the cost of premiums for private health plans. Ryan has called the vouchers "premium support."
The outline would also transform the current Medicaid program for the poor by eliminating federal rules that establish who should be covered, such as poor children and pregnant women, and which benefits should be offered. Each state would be allowed to decide who would get coverage.
Americans who don't get coverage through an employer or through Medicare or Medicaid would qualify for a tax subsidy that they could use to help offset the cost of a commercial insurance plan.
That system of subsidies to help people buy insurance is broadly similar to the current marketplace system created by the Affordable Care Act. But the House GOP plan would not link the tax credit to people's incomes, as the current law does, potentially leaving lower-income consumers with less help to purchase insurance.
The plan does not specify how generous the subsidy would be, but a senior House GOP official told reporters that the goal would be to at least allow people to buy a plan that would cover catastrophic health problems – something considerably less comprehensive than what the current law does.The missing details make it impossible to gauge how many people could lose or gain health coverage and how much more some Americans might have to pay for coverage.
But as Ryan's emphasis on "quality" rather than "quantity" indicates, there's a strong possibility that under the Republican plan, the percentage of people without insurance – currently at an all-time low – could begin to rise again.
The new House GOP plan's architects argue that the reduced federal regulations and requirements will make coverage more affordable for everyone.
Repealing the current law, however, which House Republicans say needs to be the starting point for future reforms, would leave 24 million more Americans without health coverage, according to one recent estimate from the Washington-based Urban Institute.
The White House chided Republicans for their "obsession" with attacking the healthcare law. "The proposal introduced by Speaker Ryan is nothing more than vague and recycled ideas to take health insurance away from millions and increase costs for seniors and hardworking families," spokeswoman Katie Hill said.
Independent analysts of previous GOP plans have noted that scaling back federal oversight of state Medicaid programs, while giving states more flexibility, could prompt some states to roll back their healthcare safety nets. Converting Medicare to a voucher-based system would probably leave many seniors with bigger healthcare bills, those analyses have found.
"The current standards are designed to ensure that very vulnerable populations have access to needed care so coverage is affordable to low-income people," said Edwin Park, vice president for health policy at the left-leaning Center on Budget and Policy Priorities in Washington. "Those protections are in place for a reason."
Senior House Republican officials said details could be worked out by House committees.
It is not clear when that might happen.
Staff Writer David Lauter in Washington contributed to this report.
12:03 p.m.: This article as updated with a statement from the White House.
11:28 a.m.: This article was updated with quotes from Speaker Ryan.