Maine Sen. Susan Collins and Louisiana Sen. Bill Cassidy have unveiled the Patient Freedom Act as a replacement for the Affordable Care Act, which currently insures 20 million Americans, including about 80,000 Mainers.

Under the Collins-Cassidy bill, states would be able to keep the ACA or opt for another plan that would allow them to automatically insure the uninsured in a high-deductible plan with several thousand dollars in federal funds deposited into health savings accounts for each person.

Q: What would happen to Mainers who currently have health insurance plans purchased through the Affordable Care Act?

A: For states that chose to stay in the ACA, nothing would change. For states that chose not to, enrollees in the health insurance marketplace and the uninsured would be automatically enrolled in health savings account plans. The federal government would deposit several thousand dollars into each account, to be used to pay for premiums, deductibles and co-pays.

Q: What is a health savings account?

A: An HSA is a tax-free medical savings account that is available to those enrolled in a high-deductible health plan. The funds can be used to pay for qualified medical expenses, including deductibles.


The money in the accounts – including the taxpayer funds – would be rolled over and would thus accumulate year-over-year. Participants also can contribute to the accounts up to certain limits.

Q: Would there be a lifetime limit to health benefits under the proposed plan?

A: Collins and Cassidy have said the Patient Freedom Act, like the ACA, would not permit insurers to place lifetime limits on how much is paid out for claims, protecting people with severe illnesses from having to pay out of pocket for catastrophic medical expenses.

Q: What health services would be covered at little or no cost under the proposed plan?

A: It’s not clear exactly what health services would be covered, although Collins and Cassidy said that some versions of prescription drugs and childhood immunizations would be included.

Q: Would those enrolled in the high-deductible plan have to pay a premium?


A: Yes, but the cost of typical premiums is unclear.

Q: What would the deductible be for those insured under the high-deductible plan?

A: It’s not known yet known.

Q: Could states that don’t operate their own health insurance marketplace choose to stay with the current ACA system?

A: Yes.

Q: Could uninsured people refuse to be enrolled in the proposed plan?


A: Yes, people can opt out of enrollment, but they would be forgoing free money.

Q: Who decides whether a state would participate in the plan? Would it be the governor, the Legislature or voters?

A: Each state would set its own rules for deciding on whether it would participate.


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