Republican Senators Dr. Bill Cassidy of Louisiana and Susan Collins of Maine have introduced a bill that could serve as an alternative to the Affordable Care Act (ACA), The New York Times reported.
The Patient Freedom Act would provide flexibility to states, allowing them to maintain policies enacted by the ACA or to implement state-based alternatives with funding equal to 95% of federal subsidies that would have been available through the ACA.
The proposal shares some features with others being floated in the House of Representatives, although it is unlikely to draw support from some conservative Republicans and has already drawn criticism from Democrats, according to The New York Times.
The proposal would keep guaranteed issue and guaranteed renewability requirements, as well as prohibitions on annual and lifetime limits and exclusions for pre-existing conditions. Additionally, it would repeal the individual and employer mandates at the federal level, as well as actuarial value requirements and age ban requirements.
States opting out of the ACA could choose to receive federal funds in the form of per beneficiary grants or refundable tax credits. In either case, the funds would be delivered directly to patients through a health savings account. States could also establish high-deductible health plans to protect against catastrophic medical expenses for patients who would otherwise be uncovered, according to The New York Times.
The bill resembles, in some ways, health reform legislation introduced by HHS Secretary nominee Rep. Dr. Tom Price (R-GA) in 2006. Price partnered with Sen. Tammy Baldwin (D-WI), who served in Congress at the time, on a plan to turn health reform over to individual states, according to Vox.
Putting health reform in the hands of states could solve several problems for Republicans. To pass comprehensive health reform through Congress, Republicans will need support from almost all of their members in both houses, as well as from some Democrats in the Senate. Dr. Aaron Carroll at The Incidental Economist argues that the bill won't get much support at the present time from either side of the aisle as "there's no reason for Dems to support this" and there hasn't been any GOP leadership support yet given to the plan.
However, some health policy experts have applauded the idea, according to Vox. “I like the plan,” Ezekiel Emanuel, a professor at University of Pennsylvania who helped craft the ACA, told Vox. “I am for experimentation.”
Here were some reactions from Health Policy Twitter:
Based on this summary, the Cassidy-Sessions plan basically block grants the ACA with a cut in federal funding of 5%.https://t.co/KPsNuUaMEI— Larry Levitt (@larry_levitt) January 23, 2017
From my reading, the Roth HSA funding formula would also favor states with super high premiums (& thus subsidies) today.— Loren Adler (@LorenAdler) January 24, 2017
Nothing in the ACA is so actuarially dubious and broadly popular as the under-26 provision. (I 100% loved it while using it.) https://t.co/KaN8s0c1rt— Adrianna McIntyre (@onceuponA) January 24, 2017