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Republican Sens. Bill Cassidy and Susan Collins introduced the first Affordable Care Act replacement bill from the GOP on Monday, called the Patient Freedom Act.
Based on the fact sheet for the bill, it’s a curious opening salvo from the party. It appears that the replacement would give states the option to keep nearly all of the law intact if they wish.
The bill has three options for how states can cover people:
“Reimplementation of the ACA.” This option would allow states to put most of the provisions of the ACA, which is also known as Obamacare, back into place, including the individual mandate and Medicaid expansion. Funding from the federal government would remain the same for Medicaid expansion, cost-sharing subsidies, and premium subsidies up to 95% of current outlays. “Choose a new state alternative.” This would allow states to create a “new market-based system” with federal funding “equal to 95% of federal premium tax credits and cost-sharing subsidies” and having “per beneficiary grants or advanceable, refundable tax credits” deposited directly in health savings accounts. “Design an alternative solution without federal assistance.” This would allow states to create their own individual market solution with no funding from the federal government.
The bill, according to the fact sheet, would keep in place a number of provisions of the ACA, including not allowing insurers to deny coverage because of a preexisting condition, allowing children to stay on their parents’ insurance until age 26, and prohibiting lifetime limits.
It does, however, repeal mandates on certain baselines for coverage (the fact sheet did not specify what types of coverage), the provision that premiums for elderly people can be only three times that of young people, and other clauses.
Larry Levitt, senior vice president at the Kaiser Family Foundation, a nonpartisan healthcare think tank, said the bill appears to keep a majority of the ACA intact – to the point that it’s almost indistinguishable from the original law.
“Based on this summary, the … plan basically block grants the ACA with a cut in federal funding of 5%,” Levitt tweeted.
Levitt added that the final legislative language will be important to determining the effect of the law. Only the fact sheet has been released so far.
Senate Minority Leader Chuck Schumer pushed back on the plan, saying it would be possible some people currently insured would lose coverage and that there were concerns about keeping parts of the ACA while repealing others.
“Ultimately, this proposal is an empty facade that would create chaos – not care – for millions of Americans,” Schumer said in a statement. “Republicans should drop their disruptive repeal plans and work with Democrats to improve, not gut, the Affordable Care Act and healthcare system for all Americans.”