A week after casting a vote that may spell doom for the Affordable Care Act, U.S. Sen. Susan Collins proposed a replacement plan that would allow states to keep President Barack Obama’s signature program alive.
Collins said she will introduce legislation soon with a Louisiana colleague that “would allow states to have more choices” than the existing health care options, including “an alternative route that is more patient-centered.”
But, she said, if states “like the Affordable Care Act, they can keep the Affordable Care Act” under the measure she intends to proposed with U.S. Sen. Bill Cassidy, R-La.
Details about the new plan are scant, but it apparently would echo what she called “a more comprehensive and creative approach” Collins and Cassidy sought in 2015 called the Patient Freedom Act. That bill never got out of committee and collected only nine co-sponsors, though one of them was now-Majority Leader Mitch McConnell, R-Ky.
The 2015 version of the measure aimed to promote state-based health savings account that it said would be more market-based and affordable.
Collins said the earlier version provides “the basis for the legislation we are going to be introducing soon” that would give states more alternatives and help restrain costs. She said federal funding that would otherwise be available for Obamacare subsidies and Medicaid expansion could be bundled instead to let states pursue “a more creative route.”
U.S. Sen. Richard Durbin, D-Ill., commended Cassidy and Collins for offering a “much more reasonable” approach than those put forward in the past, though he also said he didn’t know about the merits of the plan.
Collins has often cited the need to make sure an Obamacare replacement is available before junking the program but last week voted with her GOP colleagues for a budget reconciliation plan that would end the program and remove the threat of a filibuster by opponents of the move. Maine’s other senator, independent Angus King, called the move “a serious mistake.”
This week, though, Collins is pressing ahead with a possible alternative she argues could win wide support.
In a speech on the Senate floor, Cassidy explained some of his thinking for the new proposal.
Cassidy said there “is a mandate from the American people not just to repeal but to replace. So it is not that the American people don’t want to have coverage, and they want folks with preexisting conditions to have their issues addressed, but what they are concerned about is the way Obamacare was forced upon them, with the power of Washington, DC, reaching into their own life, if you will, to their kitchen table, promising them penalties unless they comply with the Washington bureaucrats directly. That is what the American people do not like.”
He said the alternative he envisions “has the potential to cover 95 percent of Americans without a mandate. The way we do this is that as we return power to the states. We give states the option of saying that everyone who is eligible for coverage is enrolled unless they choose not to be,” in the same way that everyone who reaches age 65 is automatically covered by Medicare.
As a result, Cassidy said, unless someone specifically pulls out of the program, “he would have a health savings account so that if he goes to the urgent care center with a nail in his foot, it is covered. He has a pharmacy benefit, so that if he gets his life together while he is at that urgent care center to take an antipsychotic, he has a pharmacy benefit. Lastly, if something terrible happens, he is hit by a car or something, then he is brought to the hospital and that catastrophic coverage protects society against the cost of his hospitalization.”
Collins said she is “excited about this approach,” though she admitted on the Senate floor that it isn’t perfect.
“It’s important that we put specific proposals on the table that our colleagues can coalesce around, debate, and refine so that we can move ahead and remove the fear and uncertainty of families who are relying on coverage through the exchanges without putting an undue burden on the employers who create jobs in this country,” Maine’s senior senator said.
Collins said it’s important to have an option on the table before moving ahead with repeal of Obamacare, whether immediately or after a delay of two or three years.
“My concern with the repeal and delay plan is that the Obamacare exchanges, already on very shaky financial grounds, would go into a death spiral as consumers would face uncertainty and insurers would have no basis for pricing their policies,” she said.
Cassidy said he would like to see Obamacare repealed this year and allow states to choose the option they wish to replace it in 2018, including leaving the Affordable Health Care in place. New programs could be in place in 2019, he said, and “by 2020, the repeal and replace would have been finished.”
Durbin said there are no good options surrounding repeal of the ACA, which is “why there is a backlash across the country now, even among many Republicans as they considered the chaos” they could unleash.
He also warned “there are many complex questions that need to be addressed to satisfy all of us that we are doing the best we can do to give affordable, quality health care to more and more people across the United States.”
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