Mike Johnson Finally Reveals GOP’s Health Care Plan—and It’s Rough

House Speaker Mike Johnson just unveiled Republicans’ plan to address spiking health care costs—and it’s a disaster. 

As Affordable Care Act tax credits are set to expire in just a few weeks, sending health care costs surging for more than 20 million Americans, Republican leadership presented several bullet points Wednesday on how they plan to lower premiums and give Americans better health options. 

Instead of subsidizing premiums for those on Affordable Care Act plans, Republicans proposed introducing Health Savings Accounts, Association Health Plans, and Choice Accounts. 

Americans who don’t get insurance through their employer would be given cash directly into an account, which would reportedly be paired with a high-deductible health plan, meaning higher insurance premiums would be replaced by higher out-of-pocket costs. 

Currently, Obamacare enrollees never see the funds from their tax credits, which instead are sent directly to insurers. President Donald Trump has suggested that consumers would rather see the money themselves, what little of it there is. Republicans’ plan purports to take the burden of negotiating insurance rates away from health care providers and large companies and place it on individuals, so they can “feel like entrepreneurs,” according to Trump.

Republicans are also considering implementing cost-sharing reductions, programs that can assist low-income Americans in paying high deductibles, that were passed as part of Trump’s behemoth budget bill in July. However, the Congressional Budget Office estimates that funding these reductions will increase the number of people without health insurance by 300,000 through 2034.

Another bullet point was controversial “provider-owned hospitals,” which are directly owned and operated by the doctors. The Federation of American Hospitals published a study earlier this year finding that physician-owned hospitals, which focus on a boutique selection of treatments and services, could be damaging to community hospitals, which typically treat patients using Medicare or Medicaid and therefore operate on razor-thin margins. More provider-owned hospitals could siphon away healthier, better-insured patients.

Another point was to codify the Trump administration’s rules to “fix the ACA,” though it’s not entirely clear what that would entail.  

There were some potentially good ideas buried within their list aimed at increasing price transparency. One was to reform pharmacy benefit managers, or PBMs, a class of middlemen who manage the supply chain of prescription drugs. Critics of PBMs have suggested that consolidation among these managers has contributed to decreased transparency and thwarted competitive pricing. 

Another idea was “site neutrality,” which means that patients would pay the same prices for the same services regardless of setting—though some critics have warned that would further reduce hospital revenues. 

Johnson told Republicans that they wouldn’t implement all 10 of the proposed bullet points and that caucus members should choose two or three to pursue, NOTUS reported.

While discussion was “cordial,” a source told NOTUS, there was “no consensus” at all.