The plan claims to guarantee coverage for people with pre-existing conditions, but there is a big catch. It is only guaranteed if they maintain “continuous coverage.” If they lose a job and the insurance that went with it, they must enroll in another plan promptly or they could be locked out of insurance or charged unaffordable rates if they have pre-existing conditions.

Although the Republicans would retain the most popular provisions of the reform law, they would drop consumer protections like a ban on annual benefit limits, free preventive services, equal premiums for men and women, and comprehensive benefits designed to make sure all plans are adequate.

Federal tax credit subsidies would be limited to those earning up to three times the federal poverty level, not four times as under the existing law. How those subsidies would be paid for is not clear.

The expansion of Medicaid in 25 states and the District of Columbia, which was intended to enroll millions of uninsured Americans, would be repealed, and the amount of federal money provided for Medicaid would be capped, endangering coverage for tens of millions of Americans enrolled in Medicaid. The plan does away with the mandate that virtually all Americans obtain health insurance or pay a penalty. The mandate is a critically important element of reform because it drives young and healthy people into the insurance pools, making it possible to reduce the cost of premiums for the old and the ill. The Republicans, in eliminating the mandate, are simply hoping that insurers will offer up a batch of low-cost policies that don’t provide comprehensive benefits and will attract young and healthy consumers who don’t expect to need much medical care.

The exchanges on which consumers currently shop for private insurance would be eliminated, and no federal funds could be used to establish alternative websites; people would have to rely on brokers and private-sector websites unless a state funded its own website. One way the Republicans plan to reduce the number of uninsured people is by allowing states to enroll those who receive federal tax credits in a randomly chosen plan with a premium exactly equal to the tax credit. While this means there would be no cost to the individual in terms of premium payments, the insurance might not be worth much. Insurers could raise the deductibles and co-payments to very high levels, leaving consumers with bare-bones catastrophic coverage that might not prove adequate in a medical or financial crisis.