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Deciding the future of the Affordable Care Act

With Donald Trump set to assume the presidency on Jan. 20, a battle is brewing in Congress over his promise to repeal the Affordable Care Act even as legislators decide on its replacement. The Virginia delegation is weighing in from both sides.

On Wednesday, Rep. Dave Brat, R-Richmond, posted on Twitter that congress needed to repeal Obamacare and replace it with free market solutions to reduce costs, saying President Barack Obama’s signature legislation had resulted in skyrocketing costs for Americans.

On Thursday, U.S. Senator Tim Kaine, D-Virginia, spoke at length on the senate floor about why Republicans should not dismantle the Affordable Care Act, an action he said would strip healthcare from tens of millions of Americans.

Meanwhile, Trump continued to take to Twitter to talk about Obamacare, saying Thursday it was time for “Republicans and Democrats to get together and come up with a healthcare plan that really works—much less expensive & FAR BETTER!”

Thursday, Brat announced his reintroduction of the Health Savings Account Expansion Act with U.S. Senator Jeff Flake of Arizona. Brat said the bill would drive down healthcare costs and allow consumers to use their own funds for products and services they want versus having to get government approval for coverage, according to a release.

The proposed act would increase HSA contribution limits for single/joint filers from $9,000 to $18,000 a year and allow those tax-free funds to pay for premiums, prescriptions and primary care services.

Michael Cannon, a Forbes magazine contributory, wrote in an article last year that that large Health Savings Accounts are the most promising Obamacare replacement to date, but said congress could create them before repealing the Affordable Care Act. He wrote that the Brat-Flake plan “would be the largest-ever scaling back of the federal government’s role in health care,” calling it a $9 trillion tax cut, an amount equivalent to the current tax exclusion for employer-sponsored insurance over the next decade.

“Flake-Brat would return that money to the workers who earned it,” according to the article.

At the same time, Cannon wrote, expanding tax breaks for HSA contributions would reduce federal revenues and increase federal deficits and debts—the latter of which Brat has consistently raised the alarm about the need for reduction.

Rep. Flake, in Thursday’s release, said the HSA Expansion Act would give control back to Americans.

“If we want to lower health care costs and improve consumer choice, the key is not more government intervention, but allowing individuals the freedom to take back control of their own healthcare and incentivizing prudent decision making,” he said.

Flake said the legislation ought to be in the conversation as congress considers options for replacing Obamacare.

As of December, the uninsured rate in Virginia had fallen by 31 percent since the Affordable Care Act was enacted in 2010, translating into 327,000 residents gaining coverage, according to the U.S. Dept. of Health and Human Services.

Kaine, in his remarks this week in Congress, acknowledged the need for improving the ACA, but said that repealing it without a replacement would create chaos.

“The ACA was not only about the affordability of care, and not only about the coverage, it was also about the quality of care. Could your coverage discriminate against you because you were a woman? Could your coverage expire once you get diagnosed with an illness and now have a pre-existing condition? These bill of rights protections for patients were an important and integral part of the Affordable Care Act,” he said. “The budget point of order we would put on the table would establish a 60-vote threshold for considering any legislation that triggered one of those three concerns: reductions in coverage, increase in costs, reduction in quality.”

According to a poll released Friday by the Kaiser Family Foundation, Americans are divided on what congress should do with the ACA. Forty-nine percent of respondents said the next congress should vote to repeal the law compared to 47 percent who say they should not vote to repeal it, according to the Kaiser Family Foundation.

Of those who want congress vote to repeal, 28 percent say they want lawmakers to wait until the details of a replacement plan have been announced while 20 percent said Congress should vote to repeal the law immediately and work out the details of a replacement plan later.