GOP senators' bill would partially replace health law, give states choice

WASHINGTON -- Several Republican senators on Monday proposed a partial replacement for the Affordable Care Act that would allow states to continue operating under the law if they choose, a proposal meant to appeal to critics and supporters of former President Barack Obama's signature health law.

But the proposal -- led by Sens. Bill Cassidy of Louisiana, a medical doctor, and Susan Collins of Maine, a moderate Republican -- was attacked by Democrats as a step back from the Patient Protection and Affordable Care Act's protections. And conservative Republicans have said they want to get rid of the law and its tax increases as soon as possible.

Under the proposal, states could stay with the Affordable Care Act, or they could receive a similar amount of federal money, which consumers could use to pay for medical care and health insurance.

"We are moving the locus of repeal to state government," Cassidy said. "States should have the right to choose."

The proposal shares some features with House Republican proposals: It would encourage greater use of health savings accounts and eliminate the requirement for most Americans to have insurance or pay a tax penalty. But the option for states to keep the Affordable Care Act alive will rankle the Republicans who have been trying for nearly seven years to completely repeal it.

"Obamacare is flawed, failing and not fixable, and it needs to be fully repealed," said Rep. Mark Meadows of North Carolina, the chairman of the House Freedom Caucus.

A stalemate between the House and Senate would leave in place Obama's health law, but efforts by President Donald Trump and Congress to undermine it could send health insurance markets into a tailspin. On Friday, as one of his first official acts as president, Trump signed an executive order that allows officials to ease up on enforcement of the mandate requiring most Americans to have insurance.

Supporters of the Affordable Care Act panned Cassidy and Collins' proposal.

"Millions of Americans would be kicked off their plans, out-of-pocket costs and deductibles for consumers would skyrocket, and protections for people with pre-existing conditions, such as cancer, would be gutted," said the Senate Democratic leader, Charles Schumer of New York.

Collins said the bill would allow states to "keep the Affordable Care Act if it is working for their residents." But she predicted that most states would choose something different.

Under Cassidy and Collins' bill, states could enroll people who would otherwise be uninsured in health plans providing basic coverage. These high-deductible health plans are intended to protect consumers against catastrophic medical expenses. They would cover generic versions of prescription drugs, and they would also have to cover recommended childhood immunizations without co-payments. States would contract with one or more insurers to offer this coverage.

Consumers could buy "more robust coverage" if they want, Cassidy said, but they could be automatically enrolled, by default, in the high-deductible health plans providing basic coverage.

"A state could say, 'All those eligible are enrolled unless they choose not to be,'" he explained.

This "passive enrollment" would provide insurers with a large pool of customers, including many healthy people, without the coercion of an "individual mandate," Cassidy said.

"We think that we could cover more people than Obamacare," Cassidy said, although he acknowledged that the effects of his bill had not been analyzed by the Congressional Budget Office, which serves as Capitol Hill's official scorekeeper.

A Section on 01/24/2017

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