Vice President Pence visits conservative House members with proposal

PO2 Robert Aitchison - Very few (relatively speaking) benefitted from the insurance exchanges of the ACA. About 3/4 of the 20M that got coverage after the ACA was implemented ... got it through Medicaid and CHIP ... with 1/4 to 1/2 of those getting it through Medicaid and CHIP being eligible without the expansion of the ACA. You are right, however, that a determination on whether whatever replaces the ACA is better or worse will depend on the metrics used to evaluate one against the other.

PO2 Robert Aitchison - You'll note I never said you said the ACA wasn't fraught with problems. My point was and remains that what the metrics are will determine the outcome of the comparison. My metrics, off the cuff:

1. Is insurance required? No is better, yes is worse.
2. Are insurance providers required to include a bucket of "essential health benefits", whether needed or not? No is better, yes is worse. Customer picks what is covered.
3. Are constraints on policies across state lines eliminated? Yes is better, no is worse.
4. Must preexisting conditions be covered? Yes is OK. Yes with conditions is better still. No is worse.

There are others but the point here is that choice is a major factor. Do I want insurance? If so, what health benefits do I want? What am I willing to pay?

IMV, Medicaid and CHIP are and should be the safety net. I further believe that if someone uninsured by choice requires and receives medical care, Medicaid should cover it (pay the provider the allowed rate) ... but the cost should be recoverable depending on the income of the care recipient.

As I stated, metrics rule ... but there are differing metrics.

PO2 Robert Aitchison - 1. You may have missed the part about a Medicaid/CHIP safety net. You may want to reread it. A private system, with that, is perfectly sustainable. Be realistic - what we are really talking about here is how to provide minimum services to those that can't affort their own healthcare insurance. That is precisely what Medicaid and CHIP do. Until the ACA came along, we had private insurance, Medicare, and Medicaid/CHIP ... and about 44,000 with no coverage at all. What do we have now? About 24000 with no coverage at all, 14.5M more on Medicaid and CHIP, and a paltry 5.5 million on increasingly expensive marketplace plans with high deductibles and co-pays. Many of those 5.5 million still go to free clinics or forego health care because they can't afford the deductibles and/or co-pays.
2. Insurance that covers services you neither need nor want are a waste of money. Nobody, least of all the Republicans and insurance companies, are advocating for the elimination of those services. YOU pick the ones you want, the insurance company will provide them and charge you accordingly.
3. Don't know what difference it will make ... but it will undoubtedly increase portability or continuity when one moves from state to state.
4. Not talking here about limiting covered medical conditions ... talking about the (non-medical) conditions necessary for the coverage to go into effect. Specifically and for example, one does not want someone with a serious medical condition that is in remission ... to forego insurance up until the time the condition comes out of remission. I could have been clearer.