Say my name, say my name, if no one is around you (The Collins/Cassidy Bill). . . .

Say it with me, The Patient Freedom Act.  

We have it: the Collins/Cassidy bill has a name, it has a written outline that provides the basics, and it has growing support.  (Note: this is just one a few ideas coming together, and we will look at them all.)

If you remember, I mentioned that Susan Collins (R-ME) and Bill Cassidy (R-LA) brought forward a plan for a replacement for Obamacare.  We now have more support for the plan: Johnny Isakson (R-GA), Lindsey Graham (R-SC) and Shelley Moore Capito (R-WV)..  

The plan, The Patient Freedom Act (PFA), offers three options for states to choose from.  It follows the doctrine of States’ Rights and gives power back to the states.  However, while it does that,  the Federal Government is there if you want its financial support.  

PFA would preserve the following consumer protections:

1. Pre-existing Conditions will be covered

2. Prohibition on annual and lifetime maximums on policies

3. Keeps guaranteed issue (GI).  I have not touched on this, but in a nutshell GI means you are guaranteed to be issued a policy, regardless of age/gender/medical background. (Funny how some of these terms mean what they say, isn't it?)

4. Young adults can stay on their parent's plan until age 26

What would the PFA repeal?

1. The individual mandate - the 'fine' for not having insurance  

2. The employer mandate - the minimum value coverage and 9.66% affordability test

3. The age band requirements - checking into this one. . . .

4. The benefit mandates - the 10 Essential Health Benefits

How would the PFA work?

1. Keeping Obamacare: A state will be allowed to opt in and keep the ACA plan as it is today.  (Remember, ACA and Obamacare are the same things?  Just testing you, to see if you are listening).  The state can continue to get federal funding, allow for federal premium tax credits, cost-sharing subsidies & expanded Medicaid.  (Caveat - as long as the funding doesn't cost more than the second option below).

2. Finding a new state alternative: A state will be able to receive up to 95% of the same Federal funding it gets today under the ACA if it wants to try out a new program.  Think of it as the state incubator approach.  (This is not far off from states dipping their tokes, I mean, toes, into the legalization of marijuana.  The thought process is, while they don't get federal funding for edibles and joints, let the states figure it out and we can learn from them.)  Under this option, states can get these funds and use them as grants, tax credits or a Roth Health Savings Account (HSA).  This approach to a similar HSA program implemented by President George W. Bush - to provide pre-tax, or tax deductible, money into an account to offset deductible and other medical costs.  I will be researching this process in greater detail.

3. States are on their own -   I like to call this the "Bye Felicia" approach.  Do it yourself with NO funding or help from the Federal Government.

OK, so let's just huddle and regroup.  Hey, are you still listening?  This is important.  

I can guess what states would pick 1 & 2.  Got it, and let's not even waste time arguing the point.  But option 3, really?  I'll leave it to say; I would not want to live in a state that chooses option 3.  How is the state going to fund this and how are you going to afford health insurance?  You might not realize, and I have said I would not talk about the single payer option (I think my words were more, I will not argue the single payer option) but let's go back in time, to 2014, when Governor Peter Shumlin D-VT, pulled the plug on their proposal, Green Mountain Care.  This was the program that would cost $2.6B to run.  Vermont received $1.7B in tax revenue.  You can do the math.  And, just a little nugget of information, Shumlin won his reelection bid against Scott Milne R-VT, by only 1.1%.  And I can say, without political persecution, Vermont is not purple.  It is quite blue.  What state would want to carry this burden for their residents? 

A note on the PFA repeals - remember that pool I keep talking about?  The risk pool?  If you take away the mandate and don't require employers to participate (or at least encourage), we start to drain the water out of that risk pool, and if you are sick and jump in, it will hurt, in your pocketbook.  We need to find a way to keep the pool filled.

And regarding the PFA repealing the mandated benefits (#4 under repeal in the list above) which increase premium costs for people if they don't need them.  Look, we entered the ACA covering 8 of the ten essential benefits already.  The last two pediatric vision and dental, I can tell you that is not breaking the bank folks.  

And, again, states regulate insurance premiums much more than the federal government. I challenge you to Google state mandated benefits and your state and see what is mandated to be covered by an insurance carrier (in a fully insured funding arrangement - you can refer to yesterday's post to refresh yourself in funding - funny how this all starts to make sense).  That mandated stuff doesn't come free, additional mandated coverage options cost money and are added to your premium dollars.  As are state premium taxes & fees - Google that too.  Your state may be telling you they are not raising your taxes, but they are getting them from taxing your insurance premiums.  Here is a place you could demand transparency.  

At the end of the day, we need everyone at the table, and we need to make a concerted effort to implement and change with a cool head.  The healthcare system is extremely delicate and cannot take a hard strike against it without breaking.  Even the ACA was a 7-year implementation - of which a lot of it was changed, massaged and delayed.  Some parts have yet to be implemented, such as the Cadillac tax.

Calm, cool and collected - that is what we need right now when it comes to the system we have to provide healthcare to us.