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Today in Obamacare: an interview with Sen. Bill Cassidy on his replacement plan

GOP Lawmakers Hold News Conference On Free Market Healthcare Plan Photo by Alex Wong/Getty Images

Sen. Bill Cassidy dives into the details of his Obamacare replacement

Sen. Bill Cassidy (R-LA) has become a key player in the Obamacare repeal and replace fight. Earlier this week he introduced a bill with Sen. Susan Collins (R-ME) that would allow states that like the Affordable Care Act to keep it — and states that don’t like it to replace it with something else, or nothing at all.

You can read my explainer on the Cassidy-Collins bill here. I got to talk to Sen. Cassidy earlier this morning in an interview for C-SPAN’s Newsmaker program, which will air Sunday morning at 10 am. Here are a few moments I found especially interesting from our discussion.

Cassidy proposed higher subsidies specifically for women in their 20s. I asked Sen. Cassidy about how his plan would end the health care law’s essential health benefits package, meaning that insurers wouldn’t have to cover things like maternity care. I asked what would happen to women who are pregnant and buy their own coverage or those with mental health needs — would it be like the pre-Obamacare market where insurers simply wouldn’t cover those things? His answer was a bit surprising, and isn’t something in his health care bill:

Among the essential health benefits, the one we do keep is mental health. That is the one time that someone may be incapable of making an informed decision.

Number two, let’s speak about pregnant women. I’ll speak about what is in our bill and what we hope to accomplish going forward. Turns out, women in their 20s cost more to care for than men. They have children. One thing I would like to do is give women in their 20s a greater credit. So, for example, we’ve seen stats that women in their 20s cost 1.64 times that of a man. As a physician, I think they should get 1.64 times the credit.

I pushed Cassidy a bit on this — what good would the credit do if insurance plans decided not to cover maternity services? Here’s what he said:

Imagine she and her husband have HSAs with a high-deductible health plan. It may be that she moves into the high deductible health plan portion. Let’s imagine between them they have the cash value for $4,000 of a cash savings account, then their high deductible health plan starts picking up everything after $6,000, so there might be a $2,000 gap. But other family members could chip in from their health savings account to help cover that exposure.

This all makes sense if you’re talking about a health insurance plan that covers maternity benefits. But this didn’t really answer the core question: What happens if insurance plans decide not to cover maternity benefits, or other benefits, at all? One could presumably use some money from an HSA to pay for maternity care that an insurer won’t reimburse. But having a baby is expensive — on average, upward of $18,000 for a vaginal birth, not to mention all the care beforehand. Unless we’re talking about some super-sized tax credits, that could leave a new mom with really high medical bills.

Cassidy doesn’t think Republicans can have a replacement plan in effect by April. At the Republican retreat this week, House Speaker Paul Ryan suggested that his party would be able to repeal and replace the Affordable Care Act by April. Politico’s Seung Min Kim, who joined me for the interview, asked whether that timeline was realistic. Here’s how he responded:

I don’t think so.

Let me start over, because when we say repeal and replace, everybody assumes there is going to be a “let there be light” moment. That at one point in time everything goes away and something comes up. I think if you listen carefully to what Paul Ryan says, he says it should be done concomitantly and there should be a transition period. We shouldn’t pull the rug out from under people.

Sen. Cassidy reached out on Twitter to further clarify his stance after the interview.

Cassidy has talked to “five or six or seven different Democratic senators” about his plan, and is setting up a meeting with Rep. Tom Price. While Sen. Cassidy pitched his bill as a compromise that would allow the states that like Obamacare to keep the health care law, Democrats immediately attacked the proposal for allowing some states to roll back the law and provide nothing in its place.

Cassidy says he has met with about a half-dozen Democratic senators about his proposal and is reaching out to more. “Chuck Schumer criticized it, saying things that were not true before he read the bill,” he said. “I know it was before he read the bill because we had not yet introduced it. He’s trying to crack the whip, telling his senators, ‘you listen to me, even if this is an attractive bill.”’

Cassidy has not met with the Trump administration yet, but said he asked his staff earlier that day to get him an appointment with Rep. Tom Price, Trump’s pick to run Health and Human Services, so he could discuss the plan he is working on.

You can watch the entire interview on C-SPAN Sunday morning at 10 am Eastern.

Meanwhile, in Philadelphia: Republicans don’t know what to do next

The GOP still isn’t anywhere close to a consensus on how it will proceed with Obamacare repeal — as a secretly recorded tape obtained by the Washington Post’s Mike DeBonis makes indisputably clear.

The recording, from a closed-door discussion at the Republican congressional retreat in Philadelphia this week, makes clear that even the most basic points about which parts of Obamacare should be repealed and what should replace them remain unsettled. Check out more from DeBonis’s great scoop at the Post.

Graph of the day

The Trump administration has halted ads for Obamacare five days before the end of open enrollment — and this graph above shows why that might be incredibly damaging for the law.

It shows that, in previous open enrollments, young people wait until the end of the sign-up period to purchase coverage. And that makes sense: When you’re healthy, you’re not as worried about making sure you have insurance.

When open enrollment started in 2015, young adults were less than a quarter of enrollees. By the January 31 deadline, they were up to 37 percent.

Young people are essential to the function of Obamacare marketplaces. Any health insurance pool needs relatively healthy people to jump in, to balance out the higher medical bills that older enrollees tend to have. A move like this could cause disruption by making it harder for the health care law to reach the exact people the marketplaces need the most.

Kliff Notes: Today’s top three health policy reads

At Party retreat, GOP still searching for consensus”: “Rank-and-file Republicans said they are coalescing around a strategy that would not have a single replacement for the Affordable Care Act. Instead they foresee a combination of changes they can make to the law through a budget bill that only requires 51 votes in the Senate, regulatory action and executive orders by the Trump administration, and individual bills addressing smaller aspects of the health system that will follow later.” — Julie Rovner, Kaiser Health News

Most people are worried about an Obamacare repeal”: “56 percent of adults are ‘extremely’ or ‘very’ concerned that many people will lose health-care coverage if Obamacare is repealed.” — Neal Rothschild, Axios

“Insurance regulators weigh in on why selling across state lines can be problematic”: “We strongly oppose legislation that would preempt state authority. We continue to see proposals that would preempt state licensing requirements and, thus, consumer protections by allowing sales across state lines by federal edict, without proper discretion for the states to form compacts between themselves.” — National Association of Insurance Commissioners

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