House Speaker Paul Ryan unveiled the health care component of congressional Republicans’ policy agenda Wednesday, a long-awaited alternative to the Affordable Care Act.

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Today House Republicans offered up an outline of what America’s health care system might look like under a future Republican president. Their plan calls for more options for health insurance policies and the possibility of lower cost. It also includes fewer safeguards for people who get sick. NPR’s Scott Horsley reports.

SCOTT HORSLEY, BYLINE: Ever since Democrats in Congress passed Obamacare more than six years ago, Republicans have been vowing to repeal it. But for the most part, they have not said what they want to replace it with until now.

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PAUL RYAN: Here it is, a real plan in black and white right here.

HORSLEY: House Speaker Paul Ryan unveiled the Republican health care plan this afternoon at a conservative think tank here in Washington. He says it represents not just a change in policy from Obamacare, but a whole different philosophy.

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RYAN: Either we have the government forcing us and telling us what we have to do, where we have to do it and how much we have to pay for it or we put ourselves in charge – we as consumers, as patients.

HORSLEY: The GOP plan would do away with the regulated exchanges in Obamacare and replace them with a more wide-open insurance market. Health policy expert Joseph Antos of the conservative American Enterprise Institute says customers would have more freedom to buy stripped down policies across state lines if they want to. And companies could offer a wider range of prices depending on a patient’s age.

JOSEPH ANTOS: If you want younger healthier people to sign on – you’ve got to – you have to mark it up so that young people will in fact be attracted to those policies.

HORSLEY: Customers would get a tax credit to help defray the cost of insurance. Though, the GOP is not saying by how much. The plan would also limit federal spending on Medicaid for poor patients, and it would eventually overhaul Medicare, so future retirees get a fixed subsidy they could use to help buy private insurance. Congressman Ryan’s been pushing that idea for years now. Though, Antos admits it’s a political hot potato.

ANTOS: It is a brave move. The intention is to give it a shot in the arm for the health sector to find more efficient and more effective ways of providing health care.

HORSLEY: The Republican plan preserves some of the more popular elements of Obamacare like letting young adults stay on their parents’ insurance, but it doesn’t guarantee coverage to those with pre-existing medical conditions if they allow their insurance to lapse. Sarah Collins of the Commonwealth Fund, which works to promote health access says that could put tens of millions of people at risk of losing coverage.

SARA COLLINS: It is very possible that people would have difficulty maintaining continuous coverage over their lifetime just based on past experiences.

HORSLEY: The plan calls for subsidized high-risk pools to insure those with especially costly medical conditions. Collins is skeptical about the Republicans’ plan. She says Obamacare has already pushed the number of uninsured Americans to a record low, even as health care costs have grown at a slower than expected rate.

COLLINS: Overall, the law has worked well to insure millions of people and also provide cost protection and some better access to care.

HORSLEY: Speaker Ryan conceded today the GOP plan is just an outline, and he’s not aiming to pass any legislation until a new Republican president is in office.

GOP White House hopeful Donald Trump has embraced some elements of the Republican plan, though not the Medicare overhaul. If nothing else, the plan gives Ryan and his colleagues a way to change the subject any time they’re asked about Trump.

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RYAN: Next question. I got nothing for you today, man. Nice try.

HORSLEY: Scott Horsley, NPR News.

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