By Molly Beck
Gov. Scott Walker said Tuesday he would scrap President Barack Obama's signature health care law on his first day in office and replace it with a health insurance system that relies on refundable tax credits based on age instead of household income to help individuals pay for health coverage.
Walker said repealing the Affordable Care Act, also known as Obamacare, would free up $1 trillion in tax credits. Coupling that with savings from the reorganization of Medicaid would pay for his new plan, he said. But he offered few other details about cost estimates, timeline or the number of people affected.
According to the Congressional Budget Office, repealing Obamacare would kick 19 million people off insurance in the first year. Walker did not say what would happen to coverage for those people if his plan was not yet in place, and he did not take questions from reporters.
He spoke at Cass Screw Machine Products in Brooklyn Center, Minnesota. Company president Steve Wise told reporters his company has a private small-group health plan, and has seen health insurance premiums grow by 36 percent this year. He supports replacing Obamacare, but also said it's not realistic to repeal it the first day of a new presidential administration without a new plan in place.
"I don't think it's a fair thing to do to anybody after it's been the law of the land for so many years" unless a new plan can be implemented for those needing coverage immediately, said Wise.
In unveiling the first policy proposal of his bid for the 2016 Republican presidential nomination, Walker also expressed frustration that Republicans in Congress haven't yet introduced a bill to kill the health law.
"I'm willing to stand up against anyone -- including people in my own party -- I'm willing to stand up against anyone to get the job done," Walker said.
Sens. Ted Cruz of Texas, Marco Rubio of Florida, Rand Paul of Kentucky and Lindsey Graham of South Carolina are among those seeking the GOP nomination.
Walker also said on that first day as president, he would issue an executive order to undo a "special deal" Obama gave Congress, which lets the federal government pay some of congressional staffers' health insurance. He said scrapping that would light a fire under Congress to pass the repeal.
Walker also took aim at Hillary Clinton, the Democratic frontrunner, by reminding the event's audience that a health care plan (nicknamed Hillarycare) similar to Obama's law was a hallmark effort, though unsuccessful, of her time as First Lady in the 1990s and put forth during her first bid for the presidency in 2008.
"As bad as things have been under Obamacare, they'd only get worse under Hillary Clinton," Walker said.
On Twitter Clinton said the law needs to be protected, not repealed.
Polling a catalyst?
Geoffrey Skelley of the University of Virginia's Center for Politics said Walker's timing suggests he is motivated by recent polling showing Walker's support among Republicans falling. He said it's the first major policy plan to be rolled out by a Republican candidate during what he called the active campaign period.
"His appeal lies in being able to really motivate conservative voters, and this, I think, falls right in line with that," Skelley said of the plan. Skelley also said the campaign wanted to show substance, and the plan accomplishes that.
"A plan at this point is never going to be (full of) specifics -- that is very unusual," he said.
Critics noted that Walker's plan repackages some of what's included in Obama's health care law.
"It's time to recognize that the health care law is here to stay," said Robert Kraig, executive director of Citizen Action of Wisconsin.
"The Day One Patient Freedom Plan" also would open the door to shopping for health insurance across state lines and reorganize Medicaid.
In materials provided to the State Journal on Monday, Walker wrote that the plan makes health insurance "more affordable and more portable." He emphasized Tuesday that the plan would allow states to have more say over its residents' health care.
Walker wrote his plan would increase health coverage options for individuals and businesses. He also said it could lower premiums by up to 25 percent by cutting regulations and encouraging competition among insurers and providers.
The absence of details on costs and coverage estimates makes it nearly impossible to compare with current law.
Last week, the share of uninsured Americans fell below 10 percent as the Health and Human Services Department reported that 943,934 new customers had signed up for coverage since open enrollment ended on Feb. 22. More than 16 million people have gained coverage since the rollout of the health care law in 2013.
Walker and other Republican candidates have insisted they would repeal the law. The biggest hurdle Walker, and any opponent of the law, faces is getting it repealed. That would take 60 votes in the Senate -- the GOP has 54 -- and Walker's plan does not address how he would undo the law in any other way.
The U.S. Supreme Court in June upheld a key portion of the Affordable Care Act allowing for federal subsidies to defray the cost of coverage, a major defeat for opponents of the law.
While the Walker plan would repeal the ACA, it appears to use similar tools to promote coverage. For example, there would be no requirement for individuals to carry health insurance or face fines, as there is currently. But, in order to be guaranteed affordable coverage without regard to pre-existing medical problems, individuals would have to "maintain continuous, creditable coverage."
Walker, similar to current law, would also provide tax credits to help with the cost of coverage. But unlike current law, those credits of between $900 and $3,000 would be based on age, not income.
Other elements of the plan include a $1,000 refundable tax credit for anyone who signs up for a health savings account, allowing people to shop for health insurance across state lines, reorganizing Medicaid into smaller programs, and giving states more regulatory authority.
He would also allow for new health insurance purchasing agreements and deregulate the long-term care insurance market.
Donna Friedsam, health policy programs director for the UW Population Health Institute, said the Walker plan's tax credits to buy insurance, protections for people with pre-existing conditions and flexibility for people who switch jobs are similar to parts of Obama's law.
"There's a lot in here that borrows from the ACA but renames it something else," Friedsam said.
Walker's plan would allow farmers, small businesses and other groups to pool members to buy insurance, similar to ACA exchanges and co-ops, Friedsam said. His proposal would let states experiment with malpractice reform, already allowed under the federal health law, she said.
The chief difference in Walker's plan is setting up block grants for needy families on Medicaid. That could help the state save money during good economic years but reduce assistance to families during recessions, Friedsam said.
Citizen Action of Wisconsin said Walker's Medicaid block grants would "likely result in millions of moderate income Americans losing their affordable health coverage."
The governor's age-based tax credits would raise premiums for many people who get insurance on the federal exchange, the group said.
Walker also calls for letting people shop for insurance across state lines, something Friedsam said is a popular idea as long as plans are required to offer minimum benefits.
-- State Journal reporter David Wahlberg and the Associated Press contributed to this report.
(c)2015 The Wisconsin State Journal (Madison, Wis.)