Republican Sens. Bill Cassidy (LA) and Susan Collins (ME) have spoken repeatedly about the need to have an Obamacare replacement plan on hand before repealing the law, and now they've got a sort of one. They call it, of course, the Patient Freedom Act and say it "would take power from Washington and return it to state capitols in order to increase access to affordable health insurance and improve patient choice, while preserving important consumer protections."
Here's what they say it does:
Repeals: This proposal repeals burdensome federal mandates imposed by the Affordable Care Act, such as the individual mandate, the employer mandate, the actuarial value requirements that force plans to fit into one of four categories, the age band requirements that drive up costs for young people, and the benefit mandates that often force Americans to pay for coverage they don’t need and can’t afford.
Keeps: This proposal keeps essential consumer protections, including prohibitions on annual and lifetime limits, prohibition of pre-existing condition exclusions, and prohibitions on discrimination. It also preserves guaranteed issue and guaranteed renewability and allows young adults to stay on their parents’ plan until age 26, as well as preserving coverage for mental health and substance use disorders.
Based on that fact sheet, this gives the states the option to keep the law nearly entirely intact, if they wished. It gives states three options for covering people: 1) "Reimplementation of the ACA," which would keep most of the law's provisions in place—including the individual mandate and Medicaid expansion—and federal funding would be maintained for all of it at 95 percent of current outlays; 2) "Choose a new state alternative," which would allow states to create new "market-based" systems while receiving, again, 95 percent of the tax credits and cost-sharing subsidies they're now getting, with "per beneficiary grants or advanceable, refundable tax credits" deposited directly in health savings accounts; 3) "Design an alternative solution without federal assistance," which is what it sounds like—states are on their own.
So, basically, it's block granting the program with a five percent funding cut. But the second option requires some deeper examination. In the press conference introducing the legislation, Collins said that it "allows states to cover the uninsured by providing a standard plan that has a high-deductible, basic pharmaceutical coverage, some preventive care and free immunizations." So much for the idea of a "more affordable than the Affordable Care Act" Republican plan. That doesn't really fit the bill of big Republican promises that no one will lose the coverage they have now.
But will it work? This is being put forward as a compromise plan, when no one wants to compromise. It keeps all of the ACA's taxes and fees in place. Paul Ryan's House Republicans—and Trump—aren't going to support that. Democrats aren't going to support it. Senate Democratic leader Chuck Schumer dismissed it out of hand, saying it's "an empty facade that would create chaos—not care—for millions of Americans."
It does, however, allow Republicans to say that have a plan. One. That Republicans will never pass.