 House Speaker Paul D. Ryan (R-Wis.) (Photo by Mark Wilson/Getty Images) By Matt O'Brien It only took seven years, but Republicans have finally decided how they want to replace Obamacare: with a much, much less generous version of it that almost seems designed to push individual insurance markets into death spirals. I guess that's freedom? Before we get to that, though, let's recap what it is that Obamacare actually does. At the most general level, it just taxes the rich to subsidize health insurance for the poor and sick. Now, it does that in two ways. First, it expands Medicaid for households making up to 400 percent of the federal poverty level —$48,240 for an individual or $98,400 for a family of four — for states that choose to do so. And second, it tries to make individual insurance markets work for people regardless of their age or health. How? Well, the best way to think about it is as a three-legged stool. It starts by saying that insurers aren't allowed to discriminate against people with preexisting conditions, or charge older people more than three times as much as younger ones; then it makes people pay a penalty if they don't buy a plan to try to prevent them from driving up premiums by waiting till they're sick to get covered; and finally, it gives subsidies to the people who need them to be able to afford a plan. The important point here is that it helps people more the more premiums go up, and helps low-income people the most. It's no surprise, then, that Republicans have acted like this is the gravest threat to the republic since the 16th Amendment. Read the rest on Wonkblog.
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