The first legislative replacement for the Affordable Care Act of the Trump era has been unveiled, and it seems almost certain that everyone will hate it. The bill, which is sponsored by a handful of Republican senators, tries to accomplish every health care policy goal at once: It tries to preserve (most of) the Affordable Care Act, it tries to modify the Affordable Care Act, and it tries to repeal (most of) the Affordable Care Act. The legislation is being marketed as a “compromise” bill, but it’s nothing of the sort, and it would result in lots of people losing their health coverage.
The Cassidy-Collins bill, as this legislation is known, would eliminate critical portions of the Affordable Care Act: the individual mandate, the employer mandate and its minimum coverage requirements. After ripping out those provisions, it would allow states to pursue one of three options.
Under the bill, a state can opt to re-implement the Affordable Care Act within its borders, including all the mandates and most of the federal subsidies (the legislation imposes a 5 percent cut). Or a state can opt out of the ACA and rid itself of the mandates, subsidies and Medicaid expansion (though some ACA protections would remain, including the ban on discrimination based on pre-existing conditions). Or a state can choose a middle route in which the mandates are eliminated but federal funds for subsidies and the Medicaid expansion continue to flow; the money would be tied to age rather than income, and directed into health savings accounts for individuals.
So I guess the idea here is that everyone in Washington will supposedly be happy: The liberal states can still have Obamacare, the hardline conservative states can have a free-market health care Thunderdome, and the ideologically mixed states can do an exciting tightrope walk between those two options.
This will not be popular, and a lot of people in Washington will hate it for many different reasons. Let’s start with Republicans, who have spent the last seven years promising to do everything in their power to cleanse the earth of every last vestige of Obamacare. Those Republicans will hate this because it does not accomplish that goal, and not one of them is going to want to support this bill just to have some hardline crank challenge them in a primary by arguing that they voted to save Obamacare. There’s also a significant chunk of the GOP, both among the base and within the Beltway, that balks at the very idea of any government mandate or subsidy for health care.
As for Democrats, they’re not going to tolerate any sort of dismantling of the health care law they spent literally all their political capital in passing. There’s also the question of coverage. Universal health coverage is an explicit goal of the Democratic Party, and this bill is a huge step backwards. Senate minority leader Chuck Schumer, D-N.Y., has already issued a blistering statement on the proposal, saying “it is nearly impossible to keep the benefits of the Affordable Care Act without keeping the whole thing.”
