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Can the Collins-Cassidy Plan Save the Affordable Care Act?

Two Republican Senators have an interesting proposal that allows states the option to keep or reject Obamacare.

By Dwyer Gunn


Susan Collins. (Photo: Astrid Riecken/Getty Images)

Earlier this week, Republican Senators Susan Collins (of Maine) and Bill Cassidy (of Louisiana) proposed a replacement plan of sorts for the Affordable Care Act that’s since generated some buzz. Broadly speaking, their plan, the Patient Freedom Act of 2017, would grant states the ability to continue operating under the ACA, while also offering states the choice to opt out.

“California and New York, you like Obamacare, you should keep it,” Cassidy told reporters. “It’s not for us to dictate.”

Under the proposed plan, states would have three choices:

  • Option One: States could choose to “reimplement” the ACA, along with its mandates, regulatory changes, credits and subsidies, and Medicaid expansion. States would receive federal funding equivalent to 95 percent of ACA funding levels.
  • Option Two: States could implement a new “market-based alternative” for health-care coverage. Under this option, coverage would consist of a high-deductible catastrophic health plan and a (subsidized) health savings account, and states could auto-enroll eligible residents in the plan. States would again receive federal funding equivalent to 95 percent of ACA funding levels, although there’s also some bonus funding for states that opt for this option.
  • Option Three: States could opt out entirely and receive no federal funding.

The Patient Freedom Act repeals a number of the regulations contained in the ACA (excepting states that choose the first option), but leaves the ACA’s tax increases in place (that funding is necessary for the first and second options). The proposal also maintains some of the ACA’s more popular regulatory changes, including the ban on lifetime and annual caps, the provision allowing children under the age of 26 to remain on their parents’ health plan, and the ban on insurer discrimination based on race, national origin, sex, age, or disability. Insurers would not be allowed to deny coverage based on pre-existing conditions, but those protections would apply only to people who maintain continuous coverage.

So far, the plan hasn’t proven politically popular. Conservative Republicans don’t think it goes far enough, while Democrats argue it jeopardizes health care for vulnerable residents of states that are hostile to the ACA. But in the face of mounting concerns about the GOP’s ability to come up with an ACA replacement that lives up to Donald Trump’s big promises on health care, it’s worth a serious look.