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January 24, 2017

Two GOP senators release new plan: 'If states like their Obamacare, they can keep it'

Daily Briefing

    Republican Sens. Bill Cassidy (La.) and Susan Collins (Maine) on Monday introduced draft legislation to replace the Affordable Care Act (ACA) if it is repealed.

    Bill details

    The draft bill, called the Patient Freedom Act of 2017, would give states three options for health care reform:

    1. Keep major ACA provisions in place. Under the first option, states could choose to keep major ACA provisions in place, such as the law's Medicaid expansions and health insurance exchanges. Collins said, "We believe in some states the ACA is working well," adding, "If the ACA is working in your state, you can keep it."

    2. Automatically enroll the uninsured in high-deductible plans. However, Collins said the ACA also is underperforming in some states. As such, states under the draft bill could choose to receive the same amount of federal funding they have or would have received for expanding Medicaid under the ACA to implement a program that would automatically enroll uninsured residents into standard high-deductible health plans.

    Under that option, the government also would fund health savings accounts (HSAs) equaling an average of $5,000 for an individual and $10,000 for married couples. Individuals could use the HSAs to cover out-of-pocket costs, such as deductibles and copayments.

    According to Collins, the HSA amounts would vary by income and by geographic location to account for differences in insurance costs and costs-of-living. Collins said individuals with annual incomes higher than $90,000 and married couples with annual incomes higher than $150,000 would receive lower HSA amounts.

    Individuals automatically enrolled in the standard health plans and HSAs could choose to opt out of the coverage.

    3. No extra federal funding. Under the draft bill's third option, states could choose to receive no federal funding and implement their own health plans for low- and moderate-income individuals without federal assistance.

    Other details

    The draft measure would require states in 2018 to select which option they will implement. States then would be required to implement their chosen plans in 2019.

    According to USA Today, the draft bill would keep intact all taxes included in the ACA to fund the replacement plan. However, Cassidy said lawmakers could adjust those at another time.

    The draft measure also would keep in place ACA provisions that:

    • Allow individuals to stay on a parent's health plan until age 26;
    • Bar insurers from denying individuals coverage based on pre-existing medical conditions; and
    • Prohibit insurers from placing annual and lifetime caps on coverage.

    The draft bill also would require health care providers to publish the "cash prices" for services patients pay for either through their HSAs or with cash.

    Republican Sens. Johnny Isakson (Ga.) and Shelley Moore Capito (W.Va.) are co-sponsoring the measure.


    Collins said the plan seeks to insure more people than currently have coverage under the ACA. "Our goal is to expand the number of people insured," she said.

    Committee to discuss the future of Medicaid as lawmakers look to repeal the Affordable Care Act (ACA).

    Collins said she believes the proposal will appeal to both Republicans and Democrats. However, she added, "We recognize that our bill is not perfect" and "is still a work in progress." She said, "I expect that we will get many ideas from my colleagues for further refinements and we are completely open to that ... But if we do not start putting specific legislation on the table that can be debated, refined, amended and enacted, then we will fail the American people."

    Cassidy said he would like Congress to consider the measure as soon as lawmakers repeal the ACA, if they do so. He said the bill if approved would be implemented immediately.

    Some stakeholders praised the plan for looking to increase states' options on health care reform.

    Kansas state Rep. Dan Hawkins (R) said, "I personally think that's the way we should go," adding, "I think each state is different and for us to try and do one-size-fits-all across is part of the problem."

    However, others were quick to criticize the proposal, CNN reports.

    Senate Minority Leader Chuck Schumer (D-N.Y.) called the bill "a far cry from the full replacement plan (Republicans) have promised for years." He said the under the legislation, "millions of Americans would be kicked off their plans, out-of-pocket costs and deductibles for consumers would skyrocket, employer-based coverage for working families would be disrupted, and protections for people with pre-existing conditions, such as cancer, would be gutted." He added, "It is nearly impossible to keep the benefits of the [ACA] without keeping the whole thing."

    California Insurance Commissioner Dave Jones (D) said the proposal "creates the illusion that somehow those states that have enacted the [ACA] will have the opportunity to continue to do so, but they'll be denied the funds to do so." Further, he said that "for states that are offered an alternative approach, the illusion is the offer of access to [HSAs] that most Americans don't make enough to save into in any meaningful way."

    Others said the plan could be a starting point for further negotiation on a plan to replace the ACA.

    According to Collins, Sen. Dick Durbin (D-Ill.) has called the draft measure a "much more reasonable" proposal than other GOP plans to replace the ACA. However, he said lawmakers could not have a "constructive conversation" on such proposals until Republicans agree not to vote to repeal the ACA until a replacement plan is ready.

    Sam Halabi, a professor at the University of Missouri School of Law, called the draft legislation "a shrewd first move that looks like it's keeping some important benefits of [the ACA] while fulfilling this promise that Trump and the Republican party made to the American public to at least repeal the parts the public didn't like." However, he said the proposal lacks sufficient detail to predict whether it would successfully make health plans more affordable (Lawlor, Portland Press Herald, 1/23; Lee, CNN, 1/23; Reynold, WAFB, 1/23; Davis, WDSU News, 1/23; Shesgreen, USA Today, 1/23; Rainey, Times-Picayune, 1/23; Dennis, Bloomberg, 1/23; Sullivan, The Hill, 1/23; Clark et al., McClatchy/Sacramento Bee, 1/23).

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