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Under Cassidy-Collins bill, if states like the Affordable Care Act, they could keep it
Several Affordable Care Act (ACA) replacement bills have been floated by Republican senators and representatives this year, but the Patient Freedom Act (PFA), introduced on Jan. 23 as
S. 191, is drawing more attention than others due to its novel approach. In an effort to garner at least some Democratic votes in Congress, the measure would allow states that like the Affordable Care Act to keep it.
The measure, sponsored by Senators Bill Cassidy, R-M.D., and Susan Collins, R-Maine, along with Shelley Moore Capito, R, W.V., and Johnny Isakson, R-Ga., would repeal the ACA's individual and employer mandates, the actuarial value requirements and obligations to cover specific treatments and services—and then allows states to choose among three options:
The bill's sponsors posted
the text of the bill, a
press release, a
one-page description and a
section-by-section summary. Below is a roundup of some of the media coverage.
ACA Replacement Offers State Options, Roth HSAs
Timothy Jost, a professor at the Washington and Lee University School of Law in Lexington, Va., provides an overview of the proposed legislation. He comments, "It has become increasingly clear in recent days that Republicans are trying to find a way to couple ACA repeal with ACA replacement. The PFA is an attempt to build a replacement plan on Republican principles of devolution of responsibility to the states and deregulation, but in a way that might appeal to some Democrats. The bill, however, appears to have been rushed into legislative language without adequate consideration of how it would actually work and what it would cost. It may form a basis for discussion, but it is not ready for enactment." (Health Affairs)
ACA Proposal Poses Challenges for Multistate Employers
The PFA could be problematic for multistate employers, especially for those with self-insured plans, according to Chatrane Birbal, the Society for Human Resource Management's senior advisor for government relations. Self-insured employer plans are regulated by the Employee Retirement Income Security Act (ERISA) and are not subject to state insurance regulations; but the bill doesn't seem to recognize ERISA preemption, she said. ERISA has provided employers with a workable framework for employee benefits, allowing them to offer a uniform set of benefits to employees, Birbal noted, adding that "SHRM believes that the flexibility and certainty of the ERISA framework has been essential to the success of the employer-based system and should be maintained." (BLR.com)
Replacement Plan Lets Liberal States Keep Obamacare
Cassidy-Collins gives states, under option 2, the opportunity to create a default catastrophic health insurance plan with low premiums and a high deductible into which states could automatically enroll uninsured residents. The premiums would theoretically be low enough to have the tax credit cover the entire bill. States that go down this path would no longer have an individual mandate but would have the option to auto-enroll individuals into high-deductible "catastrophic" coverage. Those automatically enrolled would have to actively opt out of insurance rather than proactively sign up, but the exact logistics of administering this type of program haven't been sorted out yet.(Vox)
A Path to 60 Votes?
Cassidy suggested that keeping the health care law as an option could help garner the 60 votes it would need to pass a replacement bill in the Senate. The GOP has 52 votes in the Senate, and 60 are necessary to break a Democratic filibuster. But the bill could be a hard sell for staunch conservatives because it would not fully repeal the controversial 2010 law. The plan would also keep in place, at least initially, many of the health care law's revenue streams—including the unpopular Cadillac tax and the health insurance tax—to pay for its changes. (Roll Call)
SHRM: 'Repeal and Replace' Must Strengthen Employer-Based Health Care
The Society for Human Resource Management is urging Congress to maintain the effectiveness of the employer-based health care system, as legislators begin to supplant the health care reform law.(SHRM Online)
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Another Contender: Rand Paul’s ACA Replacement Plan
On Jan. 25, Sen. Rand Paul, R-Ky., released details on a competing Republican ACA replacement measure, the
Obamacare Replacement Act (S. 222). The Paul plan incorporates elements from other GOP proposals and among its provisions would:
SHRM Online Articles:
SHRM Health Care Reform Resource Page
Four GOP Legislative Alternatives to the ACA, United Actuarial Services, February 2017
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