Some GOP Senators Would Leave ACA Decisions to States

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Some GOP Senators Would Leave ACA Decisions to States
Calendar26 January 2017

With President Trump promising an ACA replacement bill of his own “very soon” and congressional Republicans struggling to reach agreement, two GOP senators – Bill Cassidy of Louisiana and Susan Collins of Maine – are proposing to let states choose their own path. Under the newly-proposed “Patient Freedom Act,” states would have three choices: To continue to operate under the ACA, to implement their own reforms with some federal funding and strings attached, or to design their own reforms without federal help.

The “strings” tied to the federal funding option have elements in common with other GOP proposals. Federal money that otherwise would have been used for subsidies and Medicaid expansion under the ACA would fund a tax credit to help people who buy their own insurance. The amount of the credit would not vary based on income. States could create a high-deductible catastrophic plan into which the uninsured would be automatically enrolled. The tax credit would cover the premium with enough left over to pre-fund a health savings account to help with expenses before the deductible kicked in. Although they would be automatically enrolled, people could opt out of this plan – in other words, there would be no individual mandate. (BTW, the employer mandate would go away under this option as well.)

This proposal was meant to appeal to both ACA fans and foes. “At some point in this process, we will need a bill that can get to 60 votes,” Senator Cassidy said at a press conference. “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?’” 

But with neither Republicans nor Democrats in the mood to compromise on this highly politicized issue, the proposal has not been met with enthusiasm on either side. Still, given the state of American politics today, a “red state, blue state” solution bears watching among the many proposals vying for our attention. The actual Patient Freedom Act bill was introduced Wednesday – the same day that Senator Rand Paul introduced a bill of his own (more on that later, after we’ve read it). 

Meanwhile, during his confirmation hearing on Tuesday, HHS nominee Tom Price would not directly answer questions about whether he is working with President Trump on an ACA replacement plan to be revealed shortly, as the President has stated – the plan that will provide “insurance for everybody” and be “much less expensive and much better.” All Price would commit to is that he has had conversations with the President about healthcare.

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