This week saw more discussion (but mostly speculation) on how the Affordable Care Act (ACA) would be repealed and replaced. Two more proposals sprouted up, adding to the five already on the table. Here’s a look at the repeal and replace week in review.

On Monday, Senators Susan Collins’ (R-Maine) and Bill Cassidy’s (R-La) released details of their plan. At a very high level, the Cassidy-Collins plan proposed three options for states:

  1. The states could decide to stay the course with Obamacare. They’d have to take necessary steps to affirm their choice — either executive or legislative action — but they could decide they like the way things have been working and leave them as such.
  2. The states could create an alternative to the individual mandate. Under this option, states could auto-enroll uninsured individuals into low premium, high deductible plans that would exist solely to cover catastrophic medical needs. The individual would have to opt-out if they did not wish to be covered by this plan. This is similar to how the Medicare system currently enrolls those aging into Medicare. This option also looks at pre-funding health savings accounts (HSAs) and providing subsidies to those who actively purchase their own coverage agnostic to income.
  3. The states could just figure it out themselves. In this scenario, the states would go without federal funding, decide what works best for their population and design their own plan.

Cassidy and Collins note that their plan meets the requirements set forth by President Trump to replace the ACA, expand coverage, cover pre-existing conditions, remove mandates all while lowering the cost of coverage. Like the other plans presented to-date, there is plenty of debate happening on its points and whether or not they are feasible.

On Wednesday, Rand Paul released his thoughts on what a replacement plan should look like and noted that the healthcare law should not be repealed until there is a replacement plan in place. Like many other proposals, his plan would eliminate the individual mandate. He would also give those with pre-existing conditions a two-year window to enroll in coverage before pre-ACA underwriting would kick in. Here are some other highlights:

  • Allows for insurers to sell plans in multiple states
  • A $5,000 tax credit that people can put toward a health savings account
  • Allows for HSA usage regardless of whether or not an individual or family carries a high-deductible plan
  • Allows for individuals and small businesses to pool together to try to get better premiums (Under the ACA, states had the ability to set up SHOPs that would accomplish a similar goal, but utilization was very low)

Paul’s plan proposes eliminating much more of the Affordable Care Act than the Cassidy-Collins plan.

On Thursday, House and Senate Republicans gathered in Philadelphia to try to find agreement on a path forward. House Speaker Paul Ryan told the group that a repeal and replace likely wouldn’t happen until March or April. While this is later than Trump had initially promised, Republicans have admitted they would not make the original January 27th deadline.