Senators Bill Cassidy (R., La.) and Susan Collins (R., Maine) introduced a replacement to the Affordable Care Act on Monday morning that would allow states to choose whether they want to keep Obamacare or replace it with patient-centered reform.
In contrast to other Republican proposals, the Patient Freedom Act of 2017 repeals the Affordable Care Act at the federal level but gives the states the power to keep it if they choose to do so.
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"In my plan, we repeal Obamacare on a federal level, but if states like California or New York think that Obamacare works from them, then God bless them," Cassidy said. "Under my replacement plan the state legislatures in Sacramento or Albany, rather than implementing our replacement plan, could make the decision instead to take their funding and maintain an Obamacare system in their own state."
This allows Republicans to keep both promises of fully repealing the law as well as allowing Americans to keep their health care plan if they like it. States can keep Obamacare, go with the replacement that the Patient Freedom Act offers, or opt for no federal help at all.
If a state opts for replacement, Cassidy explained, "We take all the money that a state would receive from the federal government for health care, and we allow the state to give a tax credit to each individual in that state who is eligible. With that, each person would receive a tax credit that can be spent on health insurance premiums or deposited to a Health Savings Account—or HSA—and used to pay directly for health care services."
President Donald Trump ran his campaign on the promise to repeal and replace Obamacare, offer coverage for all Americans, cover Americans with preexisting conditions, and lower costs. Cassidy believes there is no better way to achieve these goals than through this plan.
"Our goal is to increase the number of people who are insured in this country, to help restrain the growth of premiums, and to give consumers more choices," said Sen. Collins. "We do so, as Dr. Cassidy has explained, by returning options to the state."
According to Collins, states that chose the replacement would receive the same amount of money they receive now under Obamacare plus what they would receive if they expanded Medicaid, whether or not they have already chosen to do so.
This would be a generous approach, Collins said, that would allow states to cover uninsured individuals. Collins also noted that those individuals have the choice not to go into the state plan and could buy more generous coverage using their health savings account.
"At some point in this process we're going to need a bill where we get 60 votes," Cassidy explained. "Now if you can say to a blue state senator who's really invested in supporting Obamacare, ‘You can keep Obamacare, but why force it upon us?’ We think that helps us get to 60."