Opening Salvo on ACA Replacement Falls Short
On January 23, 2017, Senators Susan Collins (R- ME) and Bill Cassidy (R- LA) introduced the Patient Freedom Act of 2017 (S. 191) billed as a “comprehensive replacement plan for Obamacare.” 
According to a summary of the bill outlined on Sen. Collins’ website, it “repeals burdensome federal mandates” but “keeps essential consumer protections.” The Bill provides states with three options:
- Reimplementation of the ACA – allows states to retain ACA exchanges and federal premium tax credits, cost-sharing subsidies and Medicaid dollars, but federal funding would be capped at 95% of what it would have been under the ACA;
- Choose a new state alternative – allows states to continue to receive federal funding, again capped at 95% of ACA federal premium tax credits and cost-sharing subsidies, as well as the federal match for Medicaid expansion – these funds would be deposited into individual Health Savings Accounts (HSAs);
- Design an alternative solution without federal assistance – would “return power to the states to design and regulate insurance markets that work for their specific populations, without any federal assistance.”
While the Collins-Cassidy proposal could, in theory, allow states to keep some elements of the ACA intact, it is unclear how those elements would be maintained if other portions of the ACA are repealed. The Bill would reduce federal financial support and roll back many of the coverage gains achieved by the ACA, so it would not be a true replacement.
As noted by the Center on Budget and Policy Priorities (CBPP):
The Cassidy-Collins plan would likely leave many millions who now rely on ACA health coverage, especially those with low incomes and pre-existing health conditions, uninsured or going without needed care. That’s partly because the bill punts major decisions about how to respond to ACA repeal to the states but then scales back the federal support available to cover people.
Similarly, according to a statement from the National Health Law Program (NHeLP), the bill
would do away with many of the features that have made the Affordable Care Act successful, would increase health care costs for all Americans, and would jeopardize the health care coverage of millions because states could decide not to offer coverage.
The Center for Medicare Advocacy, along with many other advocacy organizations, has expressed grave concern about how older people and people with disabilities would be hurt by repeal of the ACA. We continue to urge that any legislation to repeal the ACA be rejected unless it is accompanied by a detailed replacement plan that provides American families with equal or improved access to high-quality, affordable health coverage. The legislation introduced by Sens. Collins and Cassidy does not meet this threshold.
Janaury 25, 2017 – D. Lipschutz
 For press releases, bill text and bill summary, see Senator Collins’ website at: https://www.collins.senate.gov/newsroom/cassidy-collins-release-legislative-text-obamacare-replacement-plan.
 See CBPP blog at: http://www.cbpp.org/blog/senators-aca-replacement-wont-likely-give-states-patients-the-choices-they-seek.
 See NHeLP statement at: http://www.healthlaw.org/news/press-releases/541-national-health-law-program-says-sens-cassidy-a-collins-have-failed-to-provide-an-aca-replacement-plan.