November 21, 2018
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Susan Collins wants to repeal Obamacare. Replacing it is a work in progress

Pete Souza | White House
Pete Souza | White House
Sen. Susan Collins (right) sits with President Barack Obama in the Oval Office in Washington, D.C., in this file photo.

The national spotlight is shining on Republican U.S. Sen. Susan Collins as part of her party’s effort to repeal the Affordable Care Act.

Collins is among a handful of Republicans calling on Congress to develop a replacement plan before dismantling President Barack Obama’s landmark health reform law. With Republicans holding a 52-48 advantage in the Senate, that small group wields considerable political leverage.

On Monday, she and Sen. Bill Cassidy, R-Louisiana, plan to unveil just such a plan, called The Patient Freedom Act of 2017, which they contend will increase choice and access to affordable health care.

The repeal effort is a constantly moving target, and the political spin cycle is set to max on anything involving the Affordable Care Act, but Collins’ new legislation is at least based on an earlier bill that gives us some clues about its major provisions. Even though the proposal is unlikely to survive consideration in the more stridently anti-Obamacare House, it’s worth examining to see what Collins thinks could resuscitate American health care.

First, a recap of her most recent actions on the issue. Last week, she joined four Republican colleagues in sponsoring an amendment to give GOP leaders more time to develop an Affordable Care Act alternative. It was tied to a bill concerning “budget reconciliation” — a tactic Congress can use to expedite action on legislation that changes taxes or spending — that sets the stage to repeal the Affordable Care Act.

Collins and her co-sponsors introduced the amendment on Jan. 10. They withdrew it shortly thereafter, and two days later, all five voted in favor of the aforementioned budget reconciliation bill, which paved the way for repealing the Affordable Care Act with no replacement plan proposed.

I asked Collins’ office for an explanation, and it provided her statement submitted for the record after last week’s vote. The senator said she was assured by Senate leaders that “there is a shared commitment that we will take the time necessary to proceed thoughtfully with legislative reforms to replace and reform the ACA.”

Her spokeswoman also characterized the budget reconciliation bill as a vehicle for Congress to discuss and debate a replacement measure, stressing that it was not the repeal bill itself.

Her office also didn’t specify whether Collins seeks to have Congress vote on a replacement plan before repealing the Affordable Care Act. However, her spokeswoman, Annie Clark, stated Collins’ No. 1 priority is “to ensure there is no gap in coverage for those who rely on the current system.”

Whether the amendment amounted to political theater or an ultimately effective tool in slowing down the repeal process is debateable, but let’s get back to the new bill coming on Monday.

The Patient Freedom Act of 2017 was originally the Patient Freedom Act of 2015, proposed as a failsafe in the event that the Supreme Court dealt a death blow to the Affordable Care Act that year. (It didn’t, upholding the tax subsidies that help millions of Americans afford health insurance under the law).

The bill, sponsored by Cassidy and co-sponsored by Collins, aimed to free states from Affordable Care Act mandates, including the requirement that everyone buy health insurance. It proposed taking all of the federal money that pays for the tax subsidies and expansion of Medicaid under the Affordable Care Act and funneling it to states, which would have had a couple of options:

— Do nothing and hang tight with the Affordable Care Act.

— Keep the funding in the form of grants administered through a state-run exchange.

— Accept the money in the form of federal dollars deposited into health savings accounts for residents. The accounts could be used to pay for health insurance or health care itself.

Cassidy also proposed allowing states to automatically enroll residents in coverage unless a resident opts out, allowing patients to change plans at any time of year, and pushing health care providers to publish their prices.

Those are just the broad strokes, and it remains to be seen how much of the 2015 bill’s language remains in the new version. But on Tuesday, Collins indicated that the new bill would keep some of the more popular consumer protections ushered in under the Affordable Care Act, including those that help people with pre-existing conditions, allow young adults to stay on a parent’s plan until age 26, and prohibit insurers from setting lifetime caps on benefits.

 

Correction: An earlier version of this report included the wrong party breakdown in the U.S. Senate. Republicans hold a 52-48 advantage.


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