What You Need To Know About The Obamacare 'Alternative' Cassidy-Collins Bill
In the days after his inauguration, President Trump has doubled down on his pledge to repeal The Affordable Care Act (Obamacare) and replace it with something "better," although he has yet to specify what that something will be. Some Republicans have called for a full-on repeal and replace, while most Democrats are hoping that Obamacare remains as is. Now, two Republican senators are pitching what they say is a middle road.
The Cassidy-Collins Plan Provides Three Basic Choices For States
On Monday, Louisiana senator Bill Cassidy and Maine Senator Susan Collins introduced legislation called "The Patient Freedom Act of 2017," which on its face provides states three options for healthcare going forward:
1. Keep The Affordable Care Act As Is
The most surprising and interesting option is allowing states to keep Obamacare, whose benefits you can review here.
[T]he proposal would offer states the possibility of sticking with Obamacare, if that's what officials would prefer. It would have to be an affirmative choice, requiring an either executive or legislative action, or both, depending on state law. But, Cassidy and Collins said, states that take the necessary steps could basically keep current arrangements in place.
2. Transition To Another Option That Auto-Enrolls The Uninsured Federally-Subsidized Catastrophic Plan
The second option, the meat of the proposed replacement for Obamacare, would give the states an option to auto-enroll the uninsured into low premium, high deductible plan meant to cover catastrophes.
States that go down this path would no longer have an individual mandate — and automatic enrollment would be meant to take its place. People would have to actively opt out of insurance rather than proactively sign up…Cassidy said at his press conference today that states would also use the tax credits to pre-fund health savings accounts, which individuals could draw from to pay medical bills while they're still within their deductibles.
The plan would redistribute premium subsidies provided under the ACA to those who purchase their own healthcare in an income-blind manner.
Cassidy confirmed at the press conference that tax credits would be distributed on a per-person basis that was agnostic to income. Under this approach, anyone up through Bill Gates would qualify for help, so long as he or she does not have an offer of insurance at work.
[Vox]
3. Design And Fund Their Own Program
The third option is for states to completely abandon the federal health program, requiring states to completely design and fund their own healthcare plan.
Design an Alternative Solution without Federal Assistance: Option 3 would return power to the States to design and regulate insurance markets that work for their specific populations, without any federal assistance.
Democrats Are Already Objecting
Schumer indicated that Democrats (at least for now) are not willing to compromise on the ACA, calling the bill "a far cry from [a] full replacement plan":
"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. All while the wealthiest few get a tax cut…It is nearly impossible to keep the benefits of the Affordable Care Act without keeping the whole thing."
[CNN]
Topher Spiro of the Center for American Progress noted the benefits of the ACA that would go missing under the alternative option in the new bill (read his full tweetstorm here):
And Republican Critics Are Already Picking It Apart
Under Obamacare's individual mandate, private citizens are ordered to buy a product or service of the federal government's choosing for the first time in all of American history. Even under Obamacare, however, the government doesn't buy people's insurance for them. (It sometimes pays for it, but at least people have to summon the minimal motivation to enroll themselves.) In having the government sign people up for insurance, "auto-enrollment" goes beyond even Obamacare's individual mandate—and hence is arguably even more of an affront to self-reliance, liberty, and limited government.
But The Threat Of A Partial Repeal Of The ACA Is Imminent
Despite concern from both Democrats and Republicans about a repeal of Obamacare before a replacement plan has been settled, the new Congress and Republican Trump administration seem poised to repeal key parts of the ACA:
Without a 60-vote supermajority in the Senate, Republicans can't repeal the entire Affordable Care Act. But they can eliminate several consequential provisions through a special budgetary process called reconciliation.
Based on a previous bill passed by the House and Senate (but eventually vetoed by President Obama), a repeal would gut significant portions of the ACA.
It would eliminate subsidies to help middle-income Americans buy their own insurance on new marketplaces. It would eliminate tax penalties for the uninsured, meant to urge everyone to obtain health insurance. And it would eliminate a number of taxes created by the law to help fund those programs.
The Bill Is Attracting Attention Because It's Seemingly A Way For An Obamacare Replacement To Get 60 Votes
The bill seems to appear to moderates in both parties — Democrats who want to keep the ACA and Republicans who want to repeal and replace:
Cassidy also suggested that keeping the health care law as an option could help Senate leadership find the 60 votes it would need to pass a replacement bill through regular order. But the bill could be a hard sell for staunch conservatives because it wouldn't fully repeal the controversial 2010 law. The plan would also keep in place, at least initially, many of the health care law's revenue streams — like the unpopular Cadillac tax and the health insurance tax — to pay for its changes.
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