The Bill Cassidy, Susan Collins Obamacare replacement plan, Patient Freedom Act, would let you keep it if you want
Two Republican senators are rolling out an Affordable Care Act replacement that they hope will appeal to the Obamacare supporters. Titled, Patient Freedom Act, the proposal puts all the responsibility on the individual state to keep Obamacare, switch to a different health insurance expansion or offer no expansion at all.
Sens. Bill Cassidy (R-LA) and Susan Collins (R-ME) held a press conference Monday with Cassidy stating that “California and New York, you like Obamacare, you should keep it, It’s not for us to dictate.”
The plans offered by House and Senate leadership would not let Obamacare continue in any form, but Senate Minority Leader Chuck Schumer (D-NY) described this new plan as “an empty facade that would create chaos.”
“At some point in this process, we will need a bill that can get to 60 votes,” Cassidy says. “Now you can say to a blue-state senator who is invested in supporting Obamacare, ‘You can keep it, but why force it on us?’”
The Cassidy-Collins proposal is a compromise, one that could preserve the Affordable Care Act in some places while letting other states try something new.
The Patient Freedom Act would, as described by Sens. Cassidy and Collins, give states three options:
- Continue to run the Affordable Care Act as is without any changes
- Switch to a different health insurance expansion that emphasizes auto-enrolling all uninsured residents into a federally subsidized catastrophic plan
- Offer no coverage expansion at all, and the state would lose the money it currently receives for insurance subsidies and Medicaid expansion
“I believe most states would embrace this option, which allows states to cover the uninsured by providing a standard plan that has a high-deductible, basic pharmaceutical coverage, some preventive care and free immunizations,” Collins said.
There are lots of details still missing from the Cassidy-Collins plan, which only exists as a one-page background document.
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.
Economist John Goodman, who helped Cassidy with the plan, argues that this would make the program much easier to administer and that “if there is an income or asset test, enrollment becomes burdensome and complicated.”
Cassidy-Collins gives states the opportunity to create a default catastrophic health insurance plan with low premiums and a high deductible into which states could automatically enroll uninsured residents. The premiums would theoretically be low enough to have the tax credit cover the entire bill.
“All those young immortals who are not about to pay through the nose on the exchanges will be automatically signed up,” Cassidy told me in an interview a few months ago, about a similar proposal of his from 2015. “You restore some of the actuarial soundness to the market.”