Sens. Bill Cassidy and Susan Collins released a plan this week that they're trying to sell as a replacement for Obamacare. It's named the "Patient Freedom Act," but a more apt description would be the "Obamacare Forever Act."
Far from representing a departure from Obamacare's approach to healthcare policy, the legislation would effectively enshrine it.
The Cassidy-Collins bill has been pitched as a bipartisan compromise that would give states the option of sticking with Obamacare or trying out a free market alternative. In practice, though, the bill wouldn't provide a legitimate choice.
One reason it can't be seen as a legitimate choice is that the law keeps Obamacare's taxes and most of its spending in place (particularly, 95 percent of its subsidies) and keeps the federal exchange infrastructure intact. That means that even if lawmakers in one state choose not to continue participating in Obamacare, their residents will still have to be paying to support the program. It also means that for the sake of inertia if nothing else, many states will stay within Obamacare.
Another reason it isn't a legitimate choice is that the law will continue to impose costly regulations at the federal level. Those include forcing insurers to cover those with pre-existing conditions, prohibiting annual or lifetime caps, requiring insurers to allow adults to remain on their parent's plans until age 26 (also known as the "slacker mandate"). Whatever the arguments are for these policies, a system of choice would leave states free to impose such requirements, but other states free to pursue alternate market-based plans. Instead, under the Cassidy-Collins plan, any state that opts out of Obamacare would continue to be restricted by its regulatory tentacles.
Though the bill claims to eliminate the law's individual mandate, it imposes a sort of mandate, by different means. States opting out of Obamacare can receive federally-funded health savings accounts for individuals. But they also have to auto-enroll residents in a base high-deductible plan with an HSA. That is, by default, everybody will be signed up for health insurance, regardless of whether they want it – and they'll have to take action to drop out. Jeffrey Anderson of the Hudson Institute has made the conservative case that this may actually be worse than Obamacare's individual mandate.
One other feature of the Obamacare mandate is that not only does it force individuals to purchase insurance, but it also makes government the arbiter of what counts as insurance. Likewise, individuals would only be able to claim HSA subsidies if they enroll in a plan that their state government has deemed to be a "qualified health plan."
Taken together, the Cassidy-Collins bill would leave residents in many states trapped in Obamacare, which all states would still be forced to pay for — and their only alternative is to adopt a system while still under onerous rules imposed from Washington.
It's true that relative to Obamacare, Cassidy-Collins would move more regulation to the states, and provide new options. But it doesn't go nearly far enough, and it occupies a dangerous middle ground.
That is, the bill wouldn't be liberating enough to help foster the development of a true free market for healthcare. Yet at the same time, it would make just enough changes, that it would allow liberals to blame any failures on free market health solutions.
As a result, a future Democratic president would be able to make the case for an even greater role for the federal government. And he or she will be inheriting a system in which much of the infrastructure of Obamacare remains intact.
If Republicans end up rallying around this bill, then Obamacare is here to stay.