Cassidy to introduce his ACA replacement plan next week

U.S. Sen. Bill Cassidy has received his “marching orders” from President-elect Donald Trump: Replace the Affordable Care Act while ensuring that everyone has insurance, making sure people with pre-existing conditions have adequate care and lowering costs.

“There aren’t many ways to get there,” Cassidy acknowledges.

But the first-term Louisiana senator could find himself at the center of the political world in Congress this year. The former doctor in the state’s charity hospital system has a replacement plan that appears to be gaining traction in D.C. He’ll introduce it next week.

As Congressional Republicans work quickly to dismantle President Barack Obama’s signature health care law, which has insured around 20 million Americans since its inception in 2010, Cassidy says his plan is the best way to keep people insured and eliminate the federal mandate that Republicans have railed against for years.

The cornerstone of Cassidy’s proposal is automatically enrolling the uninsured in a basic, no-frills, free health plan—modeled after the auto-enrollment of Medicare—as a way to circumnavigate the current mandate. It would also partially fund a health savings account for patients, and the “law of big numbers” would drive down costs, Cassidy says. He would also allow states to choose what health care plan they wanted to go with—including the option of keeping intact the tenants of the ACA, or Obamacare.

“I don’t think Louisiana is going to use a mandate, but if California wants to do it, they can do it,” Cassidy says. “If the state elects to have an auto-enroll feature, then I think it could cover more” people than Obamacare currently does.

It remains unclear whether Congressional Republicans will pick Cassidy’s bill for a replacement, and if the bill would turn into a success and cover more people than the ACA. But Cassidy argues the automatic-enroll feature is the only viable plan he is aware of to fulfill the tall order outlined by Trump.
“The devil is in the details for how do you pay for (health care),” says LSU Economics and Policy Research Director Stephen Barnes. “Can a new Republican-led reform expand coverage? Absolutely. Can it do so while lowering costs? I think it’s certainly plausible to lower the average costs, but … it’s going to have to be paid for.”

The fate of Medicaid, which several states have expanded under the ACA, including Louisiana, remains up in the air. Cassidy proposes changing the funding scheme to pay for the program on a per capita basis, and he indicated some states would ultimately receive less dollars for covering the low-income through the program.

Cassidy says he does not know whether that means Louisiana will get less money for Medicaid. The state has enrolled more than 380,000 people in Medicaid since Gov. John Bel Edwards expanded it last year. Louisiana, along with other states who have expanded the program, has saved money through the expansion as well, with the federal government paying most of the costs.

“I am encouraged that the plan (Cassidy) is proposing would allow states like ours to keep (Medicaid) expansion and the federal funds that make it a reality,” Department of Health Secretary Rebekah Gee says in a statement.

Gee says she has shared her concerns with Cassidy over GOP plans to repeal the ACA, but is ready to work with Congress and Trump’s administration to keep intact Medicaid expansion.

Barnes says Medicaid has had a significant impact in the states that have expanded it, especially in Louisiana, which receives a larger share of federal funds than others. The “vast majority” of people in the state that were covered under Medicaid expansion previously did not have insurance, he adds.

“From a Louisiana perspective, the way that program is financed matters a great deal and changes to that financing system should be done in a way that hopefully keeps Louisiana interests in mind,” Barnes says. “In public policy there is never a magic wand.”

—Sam Karlin

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