President Trump and Republicans in the Senate and House of Representatives are moving ahead with plans to repeal Obamacare.  The GOP has campaigned on dumping the Affordable Care Act almost from the day President Obama signed it into law seven years ago.

With Republicans in control of the White House and both chambers of Congress, the repeal is the easy part. The real challenge comes when President Trump and Congress try to forge agreement on a replacement. U.S. Senators Bill Cassidy (R-La.), Susan Collins (R-Maine), Shelley Moore Capito (R-W.Va.) and Johnny Isakson (R-Ga.) have established a viable starting point with their introduction of the Patient Freedom Act of 2017.

The legislation provides for three options: States could keep Obamacare, choose a new market-based system and keep the federal money or design their own plan with no funding from Washington.

“We’re moving the focus of repeal to state government,” said Cassidy, who is a medical doctor.  “States should have the right to choose.”

The bill would keep popular parts of Obamacare, including requiring insurers to cover individuals with preexisting conditions, allowing children to stay on their parents insurance until age 26, and prohibiting annual or lifetime limits on essential benefits.

Capito said the bill also retains “improvements to the federal Black Lung benefits program, which is especially important to West Virginia.”

According to a fact sheet, the proposal also “repeals burdensome federal mandates imposed by the Affordable Care Act,” such as the individual mandate and the employer mandate, which requires larger employers to provide health insurance for full-time workers.

However, insurance is based on having a pool large enough (and healthy enough) to support all claims, and this replacement bill has a new way of accomplishing that. The bill includes an automatic enrollment provision for the otherwise uninsured into plans that provide basic coverage and a high deductible.

Senator Cassidy says individuals could opt out of the automatic enrollment if they wish. “A state could say, ‘All those eligible are enrolled unless they choose not to be.’” Those who stay enrolled would also get the option to create health savings accounts to help cover out-of-pocket costs.

The bill will have critics from the left and the right. Senate Minority Leader Chuck Schumer (D-NY) excoriated it even before he saw it. “It is nearly impossible to keep the benefits of the Affordable Care Act without keeping the whole thing.” And Republicans who want all traces of Obamacare erased will object to giving states the option of keeping the ACA.

One of the reasons Obamacare is headed for repeal is that it originally passed without any Republican support.  At least some level of bipartisanship is essential on major legislation so both parties have skin in the game.

A replacement to Obamacare is inevitable and the Patient Freedom Act is a reasonable starting point from which Republicans and Democrats might just be able to find some common ground.

 

 

 

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