WASHINGTON — Four Republican U.S. Senators, including West Virginia Sen. Shelley Moore Capito, introduced Monday the Patient Freedom Act (PFA) of 2017, a bill the senators call a "comprehensive replacement plan for Obamacare."

"The Patient Freedom Act (PFA) of 2017 would take power from Washington and return it to state capitols in order to increase access to affordable health insurance and improve patient choice, while preserving important consumer protections," the release said.

"This proposal empowers patients by eliminating costly and burdensome mandates, making enrollment easy, requiring price transparency, and restoring state authority to set rules for their health insurance markets and giving patients power to make their own health care decisions."

The PFA repeals federal mandates included in the Affordable Care Act, including the individual mandate, the employer mandate, the actuarial value requirements that force plans to fit into one of four categories and the age band requirements that drive up costs for young people.

The plan does include prohibitions on annual and lifetime limits, the prohibition of pre-existing condition exclusions and prohibitions on discrimination. The plan also preserves guaranteed issue and guaranteed renewability, and allows young adults to remain on their parents' plans until age 26.

Coverage would also be preserved for mental health and substance use disorders, according to the release. Capito noted the plan would retain improvements to the federal Black Lung benefits program.

“There needs to be a replacement for Obamacare that provides access to affordable, quality health care, including to those West Virginians currently receiving coverage through the exchange or Medicaid expansion," Capito said. "The Patient Freedom Act of 2017 accomplishes this by reducing Obamacare regulations that have caused health insurance premiums to sky rocket, returning authority to states, and providing more health care choices to individuals and families."

Sen. Susan Collins, R-Maine, pointed out under the Affordable Care Act, nearly 30 million people still do not have health insurance coverage.

"Those who do have coverage are experiencing huge spikes in premium costs, deductibles and co-pays," Collins said. "Simply put, doing nothing is not an option. The Patient Freedom Act of 2017 will help ensure that more Americans have access to affordable health care that improves choice and helps restrain costs."

Collins said she hopes with this legislation, health care can move forward without gaps in coverage for those relying on the current system.

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Two different plans under the PFA were outlined in Monday's release.

The first plan would repeal Title I of the ACA, while retaining some consumer protections. This bill offers states to choose from one of the three following options: 

  • Reimplementation of the ACA: This option allows the state to reinstate Title I of the ACA, including its mandates and other requirements. The state can continue to receive federal premium tax credits, cost-sharing subsidies, and Medicaid dollars, to the extent that such subsidies do not exceed the contributions that would have been made under the second option.
  • Choose a New State Alternative: This option allows the state to enact a new market-based system that empowers patients while still ensuring those with pre-existing conditions are protected. The State could continue to receive funding equal to 95 percent of federal premium tax credits and cost-sharing subsidies, as well as the federal match for Medicaid expansion. States can choose to receive funds in the form of per beneficiary grants or advanceable, refundable tax credits, but in both cases, funds will be deposited in a Roth Health Savings Account (HSA), meaning the money will go directly to the patient.
  • Design an Alternative Solution without Federal Assistance: This option would return power to the States to design and regulate insurance markets that work for their specific populations, without any federal assistance.

The second plan would create a new state alternative with federal assistance.

This proposal provides financial assistance to legal residents of the U.S. not receiving health insurance through their employer or public programs like Medicare and Medicaid. The goal is to provide roughly the same federal benefit available to those who get insurance through their employer. To ensure that everyone is covered, states will be able to auto-enroll uninsured individuals in basic health care coverage unless that individual opts out.

The basic health plan would provide all eligible individuals with a Roth Health Savings Account, a high deductible health plan, and a basic pharmacy plan. Americans could purchase more robust coverage if they chose, and without the ACA’s restrictive mandates, the options available would not only likely be more affordable, but individuals could pick among plans to find one that best suits their specific needs. The PFA would also establish new protections for those who need emergency care, by placing limits on out-of-network surcharges for emergency medical services paid for with an HSA. The proposal also requires providers to publish “cash prices” for services paid for with an HSA or with cash.

Each state will receive the same level of funding it would have received under the ACA if 95 percent of those eligible for subsidies enrolled. In addition, the state will receive the money that would have been paid for a Medicaid expansion. If states have already expanded Medicaid, the state can choose to keep the Medicaid expansion or convert that funding into subsidies to help individuals purchase private insurance. To help Americans access health insurance, states will establish a method for depositing funds for each person directly into that individual’s Roth HSA, meaning health care dollars will go directly to the patient.