As the new Republican administration targets repeal of the Affordable Care Act, Maine’s senior senator took a major step Monday to offer a replacement plan.

U.S. Sen. Susan Collins introduced The Patient Freedom Act of 2017 with her Republican colleague Bill Cassidy of Louisiana, modeled in part on a bill they pushed two years ago that died in committee and designed to give states new options for providing health care.

The new bill aims to return power to the states, bolster patient choice and provide most of the nearly 30 million Americans who still do not have health insurance with at least a high deductibe, catastrophic coverage plan.

Collins said she wants the country “to get away from the one-size-fits-all approach” taken by supporters of Obamacare.

Even if the two senators’ measure wins congressional backing, it would not take effect fully until 2019, probably leaving at least two or three more years for the existing Obamacare, the popular name for the ACA.

Cassidy, a physician, said he wants to address “a needless and avoidable gap” in coverage so he envisions “repeal and replace as hand in glove.”

Though Collins has said she doesn’t want to repeal Obamacare until a replacement is available, she said Monday that having one “ready” is closer to the right word. She said Congress “simply can’t do all the legislative changes” required to have a successor law in place before approval of the repeal.

Some of the necessary changes could be included within budget reconciliation language, Collins said, but a full bill would have to follow to flesh out the program. She said it could done “at nearly the same time.”

The fate of Obamacare matters to the nearly 20 million Americans who have health care policies through the signature program of President Barack Obama as well as to the insurers, doctors, hospitals and medical providers who receive payments for the care they deliver to patients with the insurance.

Collins said it is important to have “real bills” for lawmakers to debate and tinker with and “not just vague concepts” about what might be possible. “I really feel strongly that is part of my job,” Collins said.

The senator said she is concerned about an executive order signed by President Donald Trump related to Obamacare – which contains confusing language, she said – because changing a law “really needs to be done by the legislature” and not the president.

Collins said one of the premises of her proposal is that states that want to keep Obamacare should be able to do so while other states could make different choices. She said she suspects a few states may want to do so.

But the default option in her new bill, which she admits isn’t perfect and will be revised, is for states to shepherd the creation of health savings accounts for everyone who doesn’t opt out. Federal cash would flow into them so people could buy the insurance they prefer, she said.

A report issued Friday by the Maine Center for Economic Policy said repeal of Obamacare would put 95,000 Mainers at risk of losing their insurance, most of them young adults or people nearing retirement.

The report said Maine medical providers would also suffer a blow, with uncompensated costs increasing nearly half-a-billion dollars annually – an expense, it warned, that could undermine the finances of the state’s health care system.

Collins said Congress is going to have to tackle Obamacare because it is “under tremendous financial strain” with policy options shrinking and premiums soaring. Without reform, she said, it “would go into a tailspin.”

The details of the new proposal are not yet available, but Collins said it would let states choose whether to keep Obamacare, adopt the default approach or simply walk away from all of it.

She said states would design their own default plans, but they would have to include basic drug coverage, some preventative items such as childhood immunizations, and popular ACA provisions such as allowing young people to stay on their parents’ insurance until they are 26. They would also bar insurers from turning away those with pre-existing conditions or imposing annual or lifetime caps on medical expenditures, Collins said.

Collins said she anticipates most people would wind up with high-deductible insurance policies under the plan. They could use the money in their health savings account to pay for the policy and, if there’s anything left, for any other medical costs, including meeting the deductible. The measure would also require transparency in pricing, she said, so patients can find out who charges what for various procedures.

States “would automatically enroll people,” Collins said, which should serve to increase the numbers who have insurance. She said most people would take advantage of the chance to purchase a policy through the program.

It would also, she said, offer a wider variety of options for people to pick from, with different price points and details.

Health savings accounts, which were also promoted in the 2015 version of the measure, are a popular alternative among GOP officials who portray them as more market-based and affordable. The earlier bill had support from U.S. Sen. Mitch McConnell, now the majority leader.

Collins recently voted for a budget reconciliation measure that included terms that would make it impossible for the Democratic minority in the Senate to filibuster any proposal that would lead to the ACA’s demise.

Since the Republicans have a 52-48 majority in the Senate, the GOP can do what it wants on the issue as long as its members stick together. Repealing Obamacare only requires 50 votes, since the vice president can break a tie, but putting a new plan in place might well require 60 since the minority can filibuster the measure. It also needs to win support in the House, where conservatives hold more sway.

U.S. Sen. Dick Durbin, D-Ill., said, “If a handful of Republican senators will say to the leadership: ‘We are not going to vote to repeal until we have a replacement,’ then we can have a constructive conversation.”

“But this notion of repealing the Affordable Care Act and then getting around to replacing it at some later time is irresponsible, will create chaos and really says to the American people: We are no longer committed to making sure your family has the peace of mind of good health insurance,” said Durbin, the assistant minority leader in the Senate.

Co-sponsor Cassidy said at a news conference Monday that shifting the choice to state “helps us get to 60” votes for passage, because some Democrats may back it since some states could retain Obamacare.

Two co-sponsors are already on board for the measure that Collins and Cassidy are offering: Republicans Shelley Moore Capito of West Virginia and Johnny Isakson of Georgia.

Capito has endorsed the idea of repealing Obamacare over a two or three-year period and using that time to figure out a replacement for it.

Capito told reporters that she doesn’t want to throw more than 200,000 people in her state who rely on the insurance they get from the program “off into the cold” by repealing the ACA right away.

“I think we’ll repeal and then we’ll work during the transition period for the replacement vehicle,” she said.

Isakson has been a fierce critic of Obamacare from the start. On Friday, he hailed the inauguration of Donald Trump as president and declared, that “we are already taking steps toward bringing relief to families and businesses by unleashing free-market competition to bring down the cost of health care and health insurance premiums.”

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