( CNN ) -- The first day of 2014 was a day to celebrate in our history -- it was the first time that all Americans could buy health insurance regardless of pre-existing medical conditions , thanks to the Affordable Care Act . But despite the good news , criticism of the ACA continues . Some Republicans have eagerly identified individuals who are not happy with the ACA . Sanjay Gupta : Better health not about Obamacare , it 's about you . As 2014—a midterm election year—dawns , it is time to ask : What does the GOP offer other than negativism ? What is the GOP alternative to the ACA , who would it help and who would it hurt ? Until now , the Republican war cry has been repeal , for which they have voted repeatedly . But ACA repeal is neither realistic , responsible , nor perhaps , even possible . The 10 titles of the ACA contain hundreds of provisions that reform Medicare payment , combat fraud and abuse , and improve health care quality . Many are already in place . Total repeal of the ACA would rip many threads already woven into the fabric of our health care system . Opinion : When will we get the verdict on Obamacare ? A targeted repeal of the less popular provisions of the ACA , the individual and employer mandates and some ACA taxes and fees , might be more feasible . But revoking the mandates would disrupt insurance markets and repealing the taxes will increase the deficit . Does the GOP have anything constructive to offer ? The answer , sadly , is not really . House Republicans have put forward two proposals -- the American Health Care Reform Act , sponsored by a majority of House Republicans , and Rep. Tom Price 's Empowering Patients First Act . Both are lengthy bills that largely recycle longstanding Republican panaceas . The American Health Care Reform Act would replace the ACA 's income-based tax credits with flat dollar tax deductions . Tax deductions are valuable to high-income Americans with high tax rates , but offer little or nothing to the low-income Americans helped by the ACA . The Empowering Patients First Act offers flat dollar tax credits that do not vary by age , geography , or health status—all of which could influence health insurance premiums . These tax credits might almost fully cover the health insurance premium of a young healthy male , but would be essentially useless to an older , low-income family , which would be left thousands of dollars short of the cost of basic coverage . The American Health Care Reform Act touts health savings accounts as the solution to every problem , but tax-subsidized health savings accounts are also primarily of value to higher-income Americans and useless to Americans whose income is too low to be taxed and who lack discretionary income to invest in health savings accounts . As the media spotlight high cost sharing under ACA plans in the coming months , it should ask how much higher cost sharing would be under the GOP plans . Conservatives , such as John Goodman , champion very high deductible policies , and Republican proposals , unlike the ACA , do not limit cost sharing . By repealing the ACA , Republicans would reinstate pre-existing condition exclusions for many of the uninsured . The primary relief they offer to the uninsured with health problems are state high-risk pools . High-risk pools , however , are very expensive , and without massive federal support would be unaffordable to many Americans . Exclusion of Americans from insurance coverage would also likely increase under Republican proposals to permit interstate health insurance sales , which could drive a race to the bottom in state insurance regulation . Association health plans have a history of undermining state reforms aimed at covering individuals and groups with pre-existing conditions . Opinion : Why I signed up for Obamacare . One can not imagine a GOP health care proposal that did not promise to place more barriers in the way of Americans injured by medical negligence who seek compensation . Although our medical litigation system could certainly use reform , proposals for change would reduce health care costs by only a small amount : half a percent , according to the Congressional Budget Office , including defensive medicine . Republican malpractice `` reform '' proposals may be politically popular , but do not address our health care system 's real problems . The GOP does not promise that if you like your insurance plan you can keep it , and with good reason . The vast majority of privately insured Americans are covered through their work . The American Health Care Reform Act would abolish current deductions and exclusions for employer-sponsored health insurance . This would not only be one of the largest middle class tax increases in American history , but could result in millions of Americans losing employer-sponsored insurance . Whatever disruptions the ACA may cause in coming months , it moves us toward more comprehensive and affordable coverage for low- and middle-income and sicker Americans . The alternatives proposed by House Republicans would be very disruptive , and unsurprisingly , benefit the healthy and wealthy . Americans must ask themselves : Who offers the most needed reforms for our health care system ? The opinions expressed in this commentary are solely those of Timothy Jost .
Timothy Jost : The first day of 2014 was a day to celebrate in our history . Jost : Despite promises of Obamacare , Republicans are critical or call for repeal . He says alternative proposals offered by House Republicans help the rich and healthy . Jost : As high cost sharing under Obamacare will be discussed , just look at GOP plans .