Sen. Collins' ACA replacement gives states greater say

Courtesy / Office of Sen. Susan Collins U.S. Sen. Susan Collins, R-Maine, speaking from the floor of the Senate last Tuesday about introducing an ACA replacement bill with U.S. Sen. Bill Cassidy, R-La. The senators introduced their bill on Monday.

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By Staff

U.S. Sens. Susan Collins, R-Maine, and Bill Cassidy, R-La., introduced legislation Monday to create a comprehensive replacement plan for Obamacare that would give Maine and other states greater say in setting rules for their health insurance markets.

In a one-page summary, the co-sponsors stated their proposed legislation, called The Patient Freedom Act of 2017, would repeal the ACA’s “individual mandate, the employer mandate, actuarial value requirements that force plans to fit into one of four categories, the age band requirements that drive up costs for young people and the benefit mandates that often force Americans to pay for coverage they don’t need and can’t afford.”

But it would keep what they characterize as “essential consumer protections,” including “prohibitions on annual and lifetime limits, prohibition of pre-existing condition exclusions and prohibitions on discrimination. It also preserves guaranteed issue and guaranteed renewability and allows young adults to stay on their parents’ plan until age 26, as well as preserving coverage for mental health and substance use disorders.”

“Our current health care system is under considerable stress and will collapse if Congress does not act,” Collins said in a statement accompanying the summary. “The ACA has been in full effect for three years, yet nearly 30 million people still do not have health insurance coverage. Those who do have coverage are experiencing huge spikes in premium costs, deductibles and co-pays. Simply put, doing nothing is not an option."

Collins said The Patient Freedom Act of 2017 "will help ensure that more Americans have access to affordable health care that improves choice and helps restrain costs." She expressed hope that the proposal offered ideas her Senate colleagues could "coalesce around, debate and refine so that our efforts can move forward with no gap in coverage for those relying on the current system.”

Cassidy, who is a medical doctor, added that the proposal meets President Trump’s stated goal when he killed the ACA that any replacement plan should achieve “health coverage for all.”

States would have choice

Under their proposal, Collins and Cassidy said states would have the freedom to choose one of three options:

Option 1: Reimplementation of the ACA: States would be allowed to reinstate Title I of the ACA, including its mandates and other requirements. The state can continue to receive federal premium tax credits, cost-sharing subsidies and Medicaid dollars, to the extent that such subsidies do not exceed the contributions that would have been made under Option 2.
Option 2: Choose a new state alternative: This option would allow states to enact a new market-based system that the summary stated “empowers patients while still ensuring those with pre-existing conditions are protected.” States could continue to receive funding equal to 95% of federal premium tax credits and cost-sharing subsidies, as well as the federal match for Medicaid expansion. States can choose to receive funds in the form of per beneficiary grants or advanceable, refundable tax credits, but in both cases, funds will be deposited in a Roth Health Savings Account, meaning the money will go directly to the patient.

Option 3: Design an alternative solution without federal assistance: This option, according to the summary, would return power to the states to design and regulate insurance markets that work for their specific populations, without any federal assistance.

The summary stated that under Option 2, states would receive the same level of funding they would receive under the ACA if 95% of those eligible for subsidies enrolled.

States also would receive the money they would have been paid for an expansion of Medicaid, which is something that Maine Gov. Paul LePage so far has successfully vetoed. States that have already expanded Medicaid can choose to keep that expansion or they can convert it into subsidies to help individuals purchase private insurance. “To help Americans access health care,” the summary stated, “states will establish a method for depositing funds for each person directly into that individual’s Roth Health Savings Account, meaning health care dollars go directly to the patient.”

The Patient Freedom Act would require providers to publish “cash prices” for services paid for with a Health Savings Account or with cash.

Democrats' response

The Advocate, a newspaper in Cassidy’s home state, reported that Senate Minority Leader Chuck Schumer, D-N.Y., characterized the GOP measure as a plan that would reduce care and drive up medical costs for consumers.

"Ultimately, this proposal is an empty facade that would create chaos — not care — for millions of Americans," he told the Associated Press.

Collins and Cassidy are joined by Republican U.S. Sens. Shelley Moore Capito, R-W.Va., and Johnny Isakson, R-Ga., as sponsors of the bill.