Senate Democrats must act right now to adopt their alternative legislative package to the American Health Care Act. Assuming there are 48 members in the Democratic Caucus (46 Democrats plus two independents), the caucus will need at least three Republicans to pass this alternative legislative package to the highly flawed AHCA (as stated by the Congressional Budget Office and opposed by scores of organizations including AARP, American Heart Association, the American Medical Association and others).

The rationale

It is incumbent for the Democratic Caucus to act as urgently as possible to advance an alternative health care bill that has better chance of covering 23 million more of our fellow Americans than the current AHCA regardless of their emotional attachment and political allegiance to the Affordable Care Act.

President Donald Trump provided us with a reasonable rationale for rejecting the AHCA and formulating a new legislative package. Recently he asserted that the House-passed AHCA was “mean,” and has expressed concerns of the bill not going far enough to protect individuals in the marketplace. He unambiguously called for the Senate to add more money to the bill.

As commentator Andrew Sprung wrote in The New York Times, we are afraid that Senate moderates may act in a dangerously passive manner in a moment so critical in our history.

The alternative health care bill we are suggesting to be formulated– one based on the Patient Freedom Act of 2017 — may provide a deal between Democrats and Republicans as a Federalist compromise.

A plan to attain and hold a majority of votes:

If a quorum of three or more of the approximately dozen Republican senators who are demurring on supporting the AHCA can be recruited to block the passage of the AHCA and defy the head of their party, the PFA could be an acceptable alternative legislation to the AHCA. Since the PFA will retain several of the ACA’s popular provisions, this can be reason enough for Democrats who are emotionally committed to retaining the ACA to work with the sponsors of the PFA to ensure its passage and enactment.

The popular provisions of ACA expected to be retained in the PFA include:

1. Ban on lifetime and annual limits
2. Coverage of adult children until age 26
3. Prohibition against pre-existing condition exclusions
4. Prohibition against health status discrimination
5. The preventive services requirement
6. Section 1557, which prohibits discrimination on the basis of race, national origin, sex, age or disability
7. Requirement for coverage of mental health and substance use disorder with limited cost-sharing as well as the extension of mental health parity rules to the health care market
8. Provision of Black Lung benefits for coal miners
9. The continuation of Section 1332 state innovation wavers
10. The continuations of the federal marketplace for states that desire to use it.

State options under the PFA are worthy of note because of the devolution of power as compared to the ACA. Also, Roth health savings accounts are at the center of the PFA’s favored option.  Any citizen or lawful alien residing in a state who is enrolled in a health care plan and not otherwise covered by a federal health program would be eligible.

The PFA (full text here) also requires providers to post their prices in a manner that will allow consumers to compare prices among providers. It also imposes specific limits on the amount of providers may bill for emergency services.

We urge the Democratic Caucus to invite the four sponsors of the Patient Freedom Act to collaboratively work on the PFA as drafted to gain the support of a majority of senators. This can enable the bipartisan group to demand the PFA be debated on the floor of the Senate and a straight up and down vote be scheduled promptly.

We must repudiate the secretive process that is being pursued by the Senate leadership and prevent the AHCA from becoming the law of the land.

We must take the initiative away from the majority leader of the Senate to enact an affordable, sustainable, innovative and equitable Health Care law based on the Patient Freedom Act.

Velandy Manohar, MD, is a Distinguished Life Fellow, American Psychiatric Association. Natasha Pillai is a medical student at Ponce Health Sciences University.

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