ACA Receives a Possible Do-Over


By Amy Jeanroy


Maine Republican Senator Susan Collins announced her part in creating a replacement bill for the Affordable Care Act; also known as Obamacare.

On Saturday, President Trump signed an executive order to “seek the prompt repeal” of the ACA.

Monday, Senator Susan Collins, along with Senators Bill Cassidy, MD (R-LA), Shelley Moore Capito (R-WV) and Johhny Isakson (R-GA) released legislative text for the Patient Freedom Act of 2017, a replacement plan for the ACA.  

According to the documentation, the Patient Freedom Act (PFA) of 2017 would ..."remove the power from Washington and return it to the state capitols to increase access to affordable health insurance and improve patient choice, while preserving important consumer protections." 

The proposal would repeal federal mandates on individuals, employers and the actuarial value requirement that makes plans fit into one of four categories. Also the age band requirement and the benefit mandates that have people paying for coverage that they don't need or can't afford. 

The proposal would keep what it calls "essential consumer protections, such as a prohibition on annual and lifetime limits, prohibition of pre-existing condition exclusions, and prohibitions on discrimination. It also guaranteed issue and renewability and allows young adults to stay on their parents' plan until age 26, as well as preserves coverage for mental health and substance use disorders. 

The PFA would offer three state options to choose from. 

1. Re-implementation of the ACA, where the state can continue to receive federal premium tax credits, cost-sharing subsidies and Medicaid dollars.

2. Choose a new state alternative where the state can enact a new market-based system that empowers patients while still ensuring those with pre-existing conditions are protected. The state would continue to receive funding equal to 95% of federal premium tax credits and cost-sharing subsidies, as well as the federal match for Medicaid expansion. States choose to receive funds in the forms of per beneficiary grants or advanceable, refundable tax credits but in both cases, funds will be deposited in a Roth Health Savings Account (HSA), meaning the money goes directly to the patient.  

3. Design an alternative solution without Federal assistance. This would return power to the states to design and regulate insurance markets that work for their specific populations, without any federal assistance. 

This proposal states that the goal is “to provide roughly the same federal benefit available to those who get insurance through their employer. States will be able to auto-enroll uninsured individuals in basic health care coverage unless that individual opts out.”

In a floor statement, Senator Collins said “Our bill is a work in progress and is not perfect; however, it is intended to put specific proposals on the table as we seek to craft bills to repair and improve the Affordable Care Act.”