If you’re following the health insurance debate—and since the coverage of more than 20 million Americans is under threat from the Trump White House and the Republican congressional majority, you should be—you’re going to be hearing a lot in the coming weeks about Cassidy-Collins. 

That’s an Obamacare replacement plan just introduced by Sens. Bill Cassidy (R-La.) and Susan Collins (R-Maine). Dubbed the Patient Freedom Act, It’s the first such proposal that indicates that the GOP is becoming increasingly panicked about the political price of repealing the Affordable Care Act outright, and increasingly desperate to reassure voters that the provisions of Obamacare they actually value can be retained without a break.

These include Obamacare’s protection of coverage for pre-existing conditions, its ban on lifetime and annual limits for benefits, and coverage of certain preventive services without co-pays. It also keeps coverage of mental health services and guarantees black-lung benefits for coal miners. The federal exchange, healthcare.gov, will continue to operate. Dependents still will be permitted to stay on their parents’ employer-sponsored plans until age 26. The measure kills the employer mandate and individual mandate, though it substitutes a “continuous coverage” system for the latter, which we’ll explain in a bit.

The goal of Cassidy-Collins is to shift the the decision of whether to keep Obamacare, dump it entirely, or come up with an alternative system to the states. (A three-page section-by-section summary is here.)

“When you speak to Americans,” Cassidy said Monday on the Senate floor, “they want their state capital to be the principal force behind how their insurance is administered, not our nation’s capital.” It’s uncertain where Cassidy got this notion, since the last governor of his own state, Republican Bobby Jindal, left 192,000 constituents, of whom 64% were black, without coverage by refusing to expand Medicaid; they couldn’t all be hailing his policy as a boon. (He was reversed last year by his successor, Democrat John Bel Edwards.)

Under Cassidy-Collins, states in which the ACA works, like California, could keep it or fashion a new system that looks very much like it. Those whose leaders have made hostility to the ACA a watchword, like Mississippi, can abandon it or create a system that provides junk insurance to residents at lower cost, while claiming they’ve saved everyone. States that expanded Medicaid to cover their neediest residents, with a federal contribution of 90% of the cost or more, can continue the program; holdout states can join in.

“The other [Republican] bills have said, ‘Let’s just get rid of Obamacare,’” says Karen Pollitz, a health reform expert at the Kaiser Family Foundation. “This one seems to be offering options.” The bill appears to maintain the ACA’s roster of taxes, including the medical device and “Cadillac” taxes and surcharges on high-income taxpayers. That’s wise, because it also maintains individual subsidies and Medicaid payments to the states, and those have to be paid for somehow.

But for the most part, Cassidy-Collins is a mess. Its initial 73-page draft brims with so many ambiguities and inconsistencies that healthcare experts who have worked their way through it still aren’t sure what some provisions mean or how they will work. Its goal of keeping some parts of Obamacare and dropping others has yielded a Rube Goldberg contraption that adds new layers of complexity to a system that should be getting simpler. Indeed, healthcare expert Timothy Jost of Washington and Lee University finds that its complexity “exceeds that of the ACA.” As a result, he says, adopting the bill would need a much longer transition period than the Jan. 1, 2018, deadline written into the text. 

The most interesting aspect of Cassidy-Collins may be that it dispenses with many of the usual GOP nostrums that are useless for improving healthcare for most Americans; that’s a sign of its sponsors’ good faith and high seriousness about healthcare that shouldn’t be overlooked. There’s nothing in the bill about tort reform or selling insurance across state lines, and only a vague reference to high-risk pools. The bill does broaden health savings accounts in a way that might chiefly benefit the wealthy, but that’s unclear.

The most important questions raised by the bill are whether healthcare policy really can be set state-by-state, and whether the measure provides enough funding to the states and their residents to make the system work.

Let’s take a look at how Cassidy-Collins is structured.

States have three options. They can keep the ACA as is, eliminate it entirely, or create their own system, within limits. No matter the choice, the ban on exclusions for pre-existing conditions, the ban on lifetime and annual benefit limits, and the guarantee of insurance for those under 26 would stay.

Under the grow-your-own choice, states—call them “option states”-- could dump such ACA mandates as the minimum essential benefits required of all individual insurance plans in the country. These include mental health and maternity coverage, vision and dental care for children, hospital care, and outpatient services. The only exceptions are childhood immunizations without co-pays, a mandate for “adequate” doctor and hospital networks, and generic drug coverage for certain (unspecified) chronic conditions, which must be included even in the default, high-deductible bare-bones plans that every option state must establish.