Republican senators unveil ACA replacement that puts states in charge

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Sens. Bill Cassidy and Susan Collins, both Republicans, unveiled an Affordable Care Act replacement bill Monday.

Two Republican senators have unveiled an Affordable Care Act replacement bill that offers flexible options for states in a bid to win crucial support from Democrats dead set against unraveling the current law.

The bill, called the Patient Freedom Act, represents a “confluence of Republican ideas,” Sen. Bill Cassidy, R-La., said during a news conference Monday. But its core principle follows the long-held GOP belief that “power is best held by individuals and states, not the federal government.”

Thus, the bill leaves it up to states to decide if they want to keep the ACA’s current framework in place, added Sen. Susan Collins, R-Maine. If a state decides to go that route, consumers will still receive subsidies and tax credits, and the consumer and employer mandates will be preserved.

Both senators said they hoped that level of flexibility will draw bipartisan support for an ACA replacement.

“At some point in this process we’re going to need a bill that will get 60 votes,” Cassidy pointed out. “Now, if you can say to a blue state senator who’s really invested in supporting Obamacare, you can keep Obamacare, but why force it on us, we think that helps us get to 60.”

For states that choose the alternative, the bill would allow them to cover the uninsured by providing a standard plan with a high deductible, basic pharmacy coverage and certain preventive care benefits, all financed by prefunded health savings accounts, Collins said. Individuals also have the option of purchasing more generous coverage.

Under this path, states would also be able to automatically enroll people who are eligible for tax credits in individual plans unless they choose otherwise—much like the Medicare program already does for seniors, Cassidy said. This, he said, will help boost enrollment and spread out the costs of caring for the sickest individuals.

States also have the option of turning to reinsurance pools or high-risk pools to help handle the costs of insuring those with preexisting conditions, Collins added. Under either option a state chooses, their bill would uphold popular ACA protections such as banning denial of coverage to the sick, allowing young adults to stay on a parent’s plan until age 26 and banning lifetime and annual limits in coverage.

Not everyone, however, was impressed with the two senators’ replacement bill.

“Contrary to the rhetoric of Sens. Cassidy and Collins, you would not be able to keep your Obamacare if you like it,” Center for American Progress Vice President for Health Policy Topher Spiro said in an emailed statement. “If you happen to live in a state controlled by those who oppose Obamacare, they would be able to gut your coverage and uproot Obamacare root and branch.”

The Congressional Budget Office has not yet scored the bill to estimate its costs, according to Cassidy, though he said he has discussed it with Senate Majority Leader Mitch McConnell, who like other GOP leaders is taking a wait-and-see approach pending the approval of Tom Price as Department of Health and Human Services secretary.

Yet Collins was quick to note that the real work of replacing the ACA should come from Congress—and it must act quickly.

“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,” she said.