Trump and Obamacare: Update on Patient Freedom Act

OBAMA & TRUMP: The two men in the White House shortly after the November 2016 election. Photo: Official White House Photo by Pete Souza/Wikimedia Commons

Trump & Obamacare: Update on Patient Freedom Act

Just weeks into Donald Trump’s presidency, it is unclear exactly what is happening to Obamacare, but he signed an executive order in January showing his commitment to dismantling the Affordable Care Act.

In the latest installment of our Trump and Obamacare series, the UMHS Endeavour looks at exactly what is projected to happen to the Affordable Care Act (ACA) under the new Trump administration, including the proposed Patient Freedom Act. We will look at information from CNN Money, MedPage Today and other online sources, and explain exactly how proposed legislation may affect doctors and future doctors in U.S. health care.

Will Patient Freedom Act Replace Obamacare?

Senior Trump advisor Kellyanne Conway told ABC News in mid-January that President Trump “wants to get rid of that Obamacare penalty almost immediately, because that is something that is really strangling a lot of Americans to have to pay a penalty for not buying,” according to an article on CNN Money.

The individual mandate, which charges Americans a penalty for not having health insurance, is likely the first part of Obamacare to be removed.

What exactly will replace Obamacare? Last month, Republican senators introduced the Patient Freedom Act, which is being called an “alternative” health-care plan to Obamacare, the website MedPage Today reported in a January 27, 2017 article. The Patient Freedom Act is noteworthy because it allows states the flexibility to either keep Obamacare or opt of it entirely. This is of particular interest to doctors and future doctors because it allows “blue” states with large Obamacare plan enrollment (New York and California, for example) to keep current health plans, guaranteeing that doctors can continue serving patients on ACA insurance plans.

States in which Obamacare enrollment is low would have the ability to opt out of the Affordable Care Act.

MedPage Today said the Patient Freedom Act would allow states to “turn to a state-run market-based option that leverages federal funds or design their own plan without these federal dollars.”

The Patient Freedom Act naturally has fans and critics alike. One of its fans told MedPage Today that the bill is “likely quite workable,” while others aren’t so sure.

“I think it’s great that Republican senators are talking about maintaining coverage. The question is whether this proposal will have political legs to make it across the finish line,” lobbyist Lauren Aronson told MedPage Today.

Ms. Aronson works for lobbying firm Mehlman, Castagnetti, Rosen & Thomas. She directed the Office of Legislation at the Centers for Medicare and Medicaid Services from 2012 to 2015.

Aronson said she worried about whether getting rid of the mandate would lead to a deterioration in the risk pool. “You need a strong hook to encourage people to buy coverage,” she said.

Senator Bill Cassidy, MD (R-La.), presented the Patient Freedom Act at a press conference in January, with Senator Susan Collins (R-Maine).

“California, New York, you love Obamacare. You can keep it,” Senator Cassidy said, noting that states where premiums are higher could choose something else.

What parts of the Affordable Care Act would the bill get rid of? Both the individual and employer mandate as well as the 3: 1 age band (limiting older adults from being charged high premiums or a 3:1 ratio), according to the website

MedPage Today says many believe this “raises costs for younger beneficiaries.”

Bill Keeps Popular Parts of Obamacare

The bill keeps some of the most popular elements of Obamacare, including not allowing insurance companies to deny coverage based on pre-existing conditions and allowing adult children to stay on their parents’ health insurance until age 26.

MedPage Today outlined three options states could choose from under the Patient Freedom Act:

  • “Re-implementing the Affordable Care Act.”
  • “Selecting a new state alternative high deductible plan that uses Roth Health Savings Accounts.”
  • “Designing a unique plan without federal assistance.”

A Roth Health Savings Account is a pre-tax savings account set up by employers for people with high-deductible health insurance plans.

“The best thing about HSAs from a tax perspective is that you are eligible to deduct the money that you contribute toward the account,” says the website “For 2016, those with individual coverage can contribute up to $3,350 to an HSA, and family coverage has a higher $6,750 contribution limit. In addition, employers are allowed to make contributions to an HSA on your behalf as well. If they do, then the money they contribute is not treated as income.”

Whether the proposed Patient Freedom Act will pass through congress remains to be seen, but it is one of the first known possible “replacements” for Obamacare.


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