Two Republicans today unveiled a proposal that could revamp the current Patient Protection and Affordable Care Act (PPACA) commercial health insurance rules and programs rather than completely replacing all of PPACA.

Rep. Pete Sessions, R-Texas, and Sen. Bill Cassidy, R-La., introduced a discussion draft of their Healthcare Accessibility, Empowerment and Liberty (HEAL) Act of 2016 bill proposal at a briefing in Washington.

Sessions and Cassidy, a medical doctor, developed the 117-page HEAL Act proposal with help from John Goodman, an economist and longtime healthy policy advisor. 

The lawmakers said they want to eliminate the PPACA individual and employer coverage mandates, repeal many PPACA-related regulations, “deregulate and denationalize” the PPACA public exchange system, and make use of a universal health insurance tax credit that would be similar to the current child tax credit.

For more details about what’s in the Sessions-Cassidy proposal, read on.

Bill Cassidy 

1. PPACA provisions the proposal would kill

PPACA imposes individual “shared responsibility” penalties on many individuals who fail to have minimum essential coverage and some employers that fail to offer affordable coverage with a minimum level.

In addition to eliminating those mandates, the Sessions-Cassidy proposal would eliminate any statutory or regulatory barriers to letting employers give workers cash that the employees can use to buy their own individual coverage.

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Metal level chessboard

 

2. PPACA provisions the proposal would keep

The Sessions-Cassidy proposal would keep the PPACA provisions that are unrelated to commercial health insurance, and they would keep some of the more popular consumer protection provisions such as the ban on annual and lifetime benefits limits; the provision letting dependents stay on coverage until age 26; and the guaranteed renewability provision.

The proposal would keep the ban on discrimination in the sale or pricing of health coverage related to personal health status, but the proposal would create a penalty charge system for consumers who have a chance to buy coverage, fail to do so, and then sign up for coverage later. If, for example, a consumer applied for new coverage without having had major medical coverage for a full year, the consumer would have to pay 20 percent more for coverage than a consumer who had maintained coverage continuously.

The proposal would keep the PPACA public exchange system in place, but it would let a state change commercial health insurance rules such as enrollment period dates and age-based pricing differences to maintain an orderly off-exchange market.

Individuals who have individual exchange coverage could keep their coverage.

See also: Trump’s health plan includes PPACA repeal, drug re-importation

A doctor seeing a patient

 

3. New programs the proposal would add

In addition to creating the universal health insurance tax credit program, which would provide an average of $2,500 per adult and $1,500 per child in 2017, the proposal would create a limited-benefit health insurance plan aimed at relatively low-income consumers with limited assets. The proposal would limit the medical debt liability of patients with the limited-benefit plans who exhausted their benefits.

The proposal includes a mandatory risk-adjustment program that would be more like the current Medicare Advantage risk-adjustment program than like the current PPACA risk-adjustment program.

The proposal also would create Roth health savings accounts (HSAs), provide the same level of tax relief for individual and employer-sponsored health benefits, and would seek to ease regulatory burdens on doctors, by encouraging doctors to start concierge practices and easing restrictions on doctor-owned health care facilities.

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