Washington — The principle of putting patients, not politicians, in the driver’s seat on health care lies at the heart of his plan to shield people in Louisiana and other states from the impact of a potential U.S. Supreme Court decision to end subsidies under the Affordable Care Act, U.S. Sen. Bill Cassidy, R-La., said Thursday.
“If the patient has the power, the system aligns to serve the patient,” Cassidy said in a presentation at the Hudson Institute, a conservative, nonprofit research group. “If a bureaucrat has the power, or a politician, it aligns to serve what they think is the best interest of the patient.
“We want the patient to have the power.”
The Supreme Court is expected to rule next month on a conservative legal challenge to the 2010 health care law, known as “Obamacare” — the signature legislative achievement of Democratic President Barack Obama. If the challenge is upheld, it will eliminate the subsidies used to help pay for health insurance by nearly 200,000 people in Louisiana and 7 million more in the three dozen other states that did not set up a state-run exchange but instead rely on a federally managed exchange.
Cassidy and other Republicans in Congress have been working on responses to a decision that would end the subsidies. That outcome would leave millions of people unable to afford their current health insurance and potentially make them angry at Republican politicians, who relentlessly criticize the Affordable Care Act and solidly support the legal challenge. Although Republicans confidently predict the challenge will succeed, that is far from certain.
Cassidy calls his proposal the Patient Freedom Act. He said he will officially introduce the legislation in the Senate in two weeks, and that U.S. Rep. Ralph Abraham, R-Alto — who, like Cassidy, is a physician — will file a companion measure in the House of Representatives.
The Cassidy plan essentially would convert the subsidies to grants to individuals and families to spend on health care and insurance — although, unlike the subsidies, the grants would not vary depending on income. The grants would be allocated on a state-by-state basis, with the amount equal to the current subsidies provided for a state’s residents plus the federal contribution to the expansion of Medicaid in that state allowed under the ACA (an expansion that Louisiana and 20 other states under Republican influence have forgone). States would have flexibility in administering the grants, but the money would have to go to patients.
The money could be distributed to patients via health savings accounts, or HSAs, a mechanism that currently exists, with debit cards linked to the accounts. Patients could make additional, pretax contributions on their own to the accounts.
Employers also could put money in their workers’ accounts, although employees who receive tax-free health-insurance coverage through their jobs — the majority of those insured nationwide — would not be eligible for the federally financed grants.
States that decide to participate would be required to offer a basic, affordable health insurance plan under the program. To broaden health insurance coverage — a goal Cassidy supports — states could automatically enroll people in the plan while allowing them to opt out if they wished.
Gone would be the Obamacare mandates on individuals and employers to buy or provide insurance, as well as most of the requirements for what the insurance must cover. Insurers would be able to adjust rates based only on age, not medical condition. The plans would be portable, and could not be canceled so long as the patient remains continuously insured.
Children could remain on their parents’ plan to age 26 — a feature of Obamacare popular with Republicans. And health care providers would have to make public what they charge for services and procedures purchased with HSA money, so that patients could comparison-shop.
Other Republicans are working on other responses to a potential court decision ending the subsidies, including proposals for a gradual phase-out of the subsidies to allow for a transition to a market without them. Cassidy said his proposal could work in concert with a transition plan.
“Some folks think there is an option to do nothing and things will work out,” Cassidy said. “That is not an option.”
Democrats in Congress are not developing plans to respond to a court decision in favor of the ACA challenge. Some Obamacare supporters are skeptical of proposals that lack mandates, or that rely heavily on state decision-making or free-market economics, for fear they would result in fewer people insured.
Should the Supreme Court challenge succeed, it is anticipated that Obama would propose a legislative fix: legalizing subsidies in federally managed exchanges.
Gov. Bobby Jindal has criticized any Republican ideas that, like Cassidy’s, maintain the Obamacare taxes and other revenues that pay for the subsidies and other features of the health care law. Jindal, who has announced that he is considering a run for the Republican nomination for president in 2016, has called for a full repeal of Obamacare. He would replace it with a plan that would offer tax deductions to reduce the cost of health insurance and that would create a fund, financed by reform of Medicaid and changes to medical lawsuit rules, that states could tap to make insurance more affordable and to provide it for those with pre-existing conditions. He rejects what he calls “the liberal shibboleth” of universal coverage.
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