Cassidy-Collins in as few words as I can manage

Lots of action on Health Twitter. Senators Cassidy and Collins have a “compromise” plan for the ACA. The highlights:

  • Revenue generators (taxes, fees) left in place.
  • Annual and lifetime limits remain.
  • Family plans still allow kids up to 26.
  • States can choose one of three (really four) options:
    1. Keep running the ACA as is
    2. Bail on the ACA entirely
    3. Take the same amount of federal money you’d get for the Medicaid expansion and subsidies and instead give it directly to your people, who will be automatically enrolled in a high deductible catastrophic plan. The money they get is based on age, not income though.
      • Leave the Medicaid expansion in place and instead do #3 only for the exchange market

I have no idea why any state would choose #2, but that’s me.


  • Pros – Many states will keep ACA as is. Medicaid expansion, too. Much of ACA left intact.
  • Cons – Many states will bail. It’s likely that states choosing option #3 (or #4) will have plans with fewer benefits. Poor people will be hit hardest, as subsidies not tied to income. (Austin reminds me that there’s a 5% cut in all subsidies)


  • Pros – States get to choose. Subsidies tied to age, not income. More defined contribution than defined benefit. Might get some “compromise” points. (There’s also the 5% cut in all subsidies)
  • Cons – Leaves much of ACA intact (taxes and fees). Leaves feds still on the hook for a lot of $$$. Some will not view this as repeal.

Let’s be honest, though. At the moment, there’s no reason for Dems to support this. It will piss off a lot of conservatives. It runs counter to President Trump’s EOs. I see no support in leadership. And, there’s no score or details on this yet. If this were pre-ACA, I might view this like Wyden-Bennett. But in today’s climate, I don’t see how this gets much support from either side at the moment.


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