Cassidy, Collins Unveil Details to ACA Replacement Proposal

A new healthcare reform legislation was introduced Monday by Bill Cassidy, MD, R-Louisiana, and Susan Collins, R-Maine. The proposed Patient Freedom Act would not fully repeal the Affordable Care Act (ACA), but would, instead, place more power in the hands of the states by giving them the option of staying with the ACA or choosing another option.

The proposal eliminates mandates, preserves consumer protections, requires price transparency, and could auto-enroll people who are eligible for tax credits. In a press conference to unveil the details of the plan, Cassidy noted that there are not a lot of ways to cover everyone and take care of people with preexisting conditions without raising costs or having mandates, which is what President Donald Trump has made clear he wants.

States that chose to stay with the ACA under the Patient Freedom Act would continue to receive subsidies and tax credits for residents and they would still be bound by the individual and employee mandates.

“California, New York, you love Obamacare, you can keep it,” Cassidy said. He added that Maine and Louisiana, which have seen premiums rise by double digit percentages year to year, would be able to opt for something different.

States that choose the alternative—which Collins believes most states will choose—would cover the uninsured population with a standard, high-deductible plan with basic pharmaceutical coverage and some preventive care. The plan would be financed through a health savings account (HSA). States would receive the same money they would have gotten under the ACA, plus what they would have received for expanding Medicaid—even if they hadn’t. However, individuals could opt out of the state plan and choose more generous health insurance coverage using their HSA to finance it. The HSAs would phase out at certain income levels, Collins explained.

Cassidy said he believed that this plan would cover more people than the ACA since states have the opportunity to auto-enroll people.

“If someone is eligible for a credit, she or he would be enrolled automatically unless they choose otherwise,” he said. “Automatic enrollment, if you will, much like when I turn 65 … I’m on Medicare. There’s no mandate—I’m on Medicare. I may call up and say ‘I don’t wish to be,’ but as a rule folks remain on Medicare.”

The final option for states would be to design an alternative solution, but without receiving federal assistance.

“Significant changes are going to need to be made in order to prevent the individual market from going into a tailspin,” Collins said. “Our goal is to increase the number of people who are insured, to help restrain the growth of premiums, and to give consumers more choices.”