Republican Lawmakers Unveil ACA Replacement Plan

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By Nathaniel Weixel

May 23 — Two Republican lawmakers May 23 unveiled legislation intended to be an alternative to the Affordable Care Act.

The bill, sponsored by Sen. Bill Cassidy (R-La.) and Rep. Pete Sessions (R-Texas), wouldn't fully repeal the ACA, which is a different approach than other Republican-backed efforts. However, it still would remove the law's mandates over employer and individual insurance coverage. Cassidy and Sessions named their bill the World's Greatest Healthcare Plan, and it comes as a House Republican task force closes in on releasing its own ACA replacement plan.

However, there's a significant difference between the two efforts.

Members of the task force have said the plan that eventually emerges from their planning sessions will be just a white paper, while Cassidy and Sessions have an actual bill. House Republicans have said on multiple occasions they don't see an immediate need to publish a bill, because it would just get vetoed, just like the ACA-repealing budget reconciliation legislation (06 HCDR, 1/11/16).

Cassidy and Sessions said they are aware of that distinction, and emphasized their bill was intended to be complementary to the task force effort.

“It's just that instead of principles, we're dropping a bill,” Sessions said. “I don't know why every idea would be stepping on anybody's toes. This is complementary.”

Even before the official May 23 rollout, Cassidy told Bloomberg BNA that having legislative language is “critical.”

“No more will Democrats be able to promote the canard that we have not proposed a bill,” Cassidy said during a May 19 conversation in the Capitol. “I’m not fighting with the House. We just want to advance the idea [of an ACA replacement], and having legislative language is significant.”

Both Cassidy and Sessions previously sponsored ACA replacement bills.

Political Realities

The lawmakers acknowledged the current political situation makes it impossible that the bill will pass any time soon. However, with an eye on the elections, Cassidy said he has reached out to the presidential campaigns, though he declined to provide specifics.

“The only way we’re going to be able to totally repeal and replace now is if we keep the House, have 60 Republicans or enough Democrats to vote with us [in the Senate], or a Republican president,” Cassidy said. “If we get that, we will go the whole way, but we can’t kind of not do anything, waiting for those stars to align.”

Having concrete legislative language in place could be helpful if Republican front-runner Donald Trump were to become president, and even Democratic front-runner Hillary Clinton has said she wants to make changes to the ACA, Cassidy said. Still, he acknowledged the Trump campaign and its voters have been anything but traditional.

“I don’t know that his voters care about solid detailed proposals,” Cassidy said. “This bill takes power away from vested interests and gives it back to the patients, so his instincts will be to like this bill. Whether it helps him? I can’t answer that, but he’s gone pretty far without being too specific.”

Legislative Policy

The central element of the bill is a $2,500 tax credit to every citizen who enrolls in the plan. The tax credit would be a flat sum, rather than income-adjusted like those offered under the ACA, so that lower-income individuals wouldn't receive more. The credit would give patients much more flexibility with how they can spend their money, said Sessions and Cassidy. The credit could be assigned to an employer, transferred to a new type of health savings account or advanced for annual distribution.

People who are covered under an ACA exchange plan would be able to keep their current coverage, the lawmakers said. States and individuals would be able to opt out of the ACA and enroll in the plan offered under the bill. Individuals could also choose not to buy insurance, without any penalty. Employers may elect to remain in the current system if they wish. However, those companies will be subject to existing penalties under the ACA.

According to a summary, the bill would also keep in place “essential consumer protections, which include guaranteed issue, guaranteed renewability, and the prohibition on discriminating against those with pre-existing conditions.”

The bill hasn't been scored by the Congressional Budget Office, but the lawmakers expect it to be budget neutral.

To contact the reporter on this story: Nathaniel Weixel in Washington at

To contact the editor responsible for this story: Brian Broderick at

For More Information

Text of the bill is at

A section-by-section summary is at