GOP senators: Give states the option of keeping ObamaCare

Greg Nash

Two Republican senators on Monday unveiled the outlines of an ObamaCare replacement plan that they hope would be able to attract some Democratic support. 

The plan, from Sens. Bill Cassidy (R-La.) and Susan Collins (R-Maine), contains less drastic changes than some Republican proposals. It envisions keeping many of ObamaCare’s taxes in place in order to provide revenue for the replacement plan and gives states the choice of whether they want to keep ObamaCare. 

Under the plan, known as the Patient Freedom Act, state legislatures would have the choice of whether to keep ObamaCare operating in their states, complete with its subsidies, mandates and protections for people with pre-existing conditions. 

Other states, the senators say, could opt into an alternative plan that would provide a uniform tax credit linked to a health savings account to help people afford a basic, less comprehensive health insurance plan. 


The lawmakers hope the ability of blue states to keep ObamaCare could help bring Democratic senators on board and get to the required 60 votes in the Senate for a replacement plan. 

“At some point in this process, we’re going to need a bill that can get 60 votes,” Cassidy said at a press conference Monday. “We think that helps us get to 60.”

“California, New York: You love ObamaCare, you can keep it,” he added. 

The plan is far from a consensus Republican proposal, though, and was swiftly rejected by the Senate’s top Democrat.


“While I have a great deal of respect for Senators Collins and Cassidy, their proposal today illustrates the dilemma both they and Republicans are in,” Senate Minority Leader Charles Schumer (D-N.Y.) said in a statement.


“Ultimately, this proposal is an empty facade that would create chaos — not care — for millions of Americans. Republicans should drop their disruptive repeal plans and work with Democrats to improve, not gut, the Affordable Care Act and healthcare system for all Americans.” 

The plan also could face blowback from conservatives, who have been adamant about repealing all of ObamaCare, including its taxes. 

Both Cassidy, a doctor, and Collins, a centrist, have been adamant that a replacement plan needs to quickly follow any vote to repeal ObamaCare. They have pushed back on Republican leaders’ idea of passing repeal first and replacing later. 

Collins said that their plan could help fill the need for a Republican replacement plan, and that more and more Republican lawmakers are coming around to the view that a replacement needs to be ready at basically the same time as repeal. 

Collins said she had seen “a sea change in attitudes on how we should approach this dilemma.”

“[There is a] growing consensus that we need not only to repeal but to replace very quickly thereafter,” she added, noting that she has been pushing that approach in Republican lunches with her colleagues.

The senators have not yet formally introduced the legislation, and details of some questions, like the size of the tax credit under the alternative to ObamaCare, were not immediately available. The senators said states that opted out of ObamaCare would get 95 percent of the federal money that they get under ObamaCare, but to use for the alternative tax credit system instead. 

The lawmakers envision that tax credit as based on a person’s age, not their income. Democrats have criticized this system as failing to give more help to low-income people and making it hard for them to afford coverage. 

Democrats also say the cheaper, less comprehensive insurance plans available under Republican proposals like this one would leave out important benefits, such as mental health coverage, or have deductibles that are too high. 

While some Republicans are pushing to repeal all of ObamaCare’s taxes, Collins and Cassidy defended the taxes as providing needed revenue for a replacement plan. Cassidy noted, though, that some of the funding sources could be altered when Republicans work on tax reform legislation.

He noted that industry groups already made deals under ObamaCare to pay increased taxes in exchange for more people being covered. 

“We may end up changing those pay-fors somewhat, but let’s recognize that universal coverage works for the business model for some of the industries that ponied up some dollars,” Cassidy said. 

Cassidy said Republican leadership is waiting before making a definitive judgment on his plan, although keeping so many parts of ObamaCare could be a tough sell to other Republicans. 

Still, Sens. Johnny Isakson (R-Ga.) and Shelley Moore Capito (R-W.Va.), have also signed onto the Cassidy-Collins plan.  

“Republican leadership is waiting to see how this plays out,” Cassidy said. “Leadership cannot get ahead of its conference.”

Still, he noted a shift towards recognition of the need for an immediate replacement. 

“There’s been a real shift towards where we want to be,” he said. 

This story was updated at 1:14 p.m.

Tags Charles Schumer Johnny Isakson Shelley Moore Capito Susan Collins
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