A month after passage of the American Health Care Act (AHCA) in the U.S. House of Representatives (House), it has moved to debate in the U.S. Senate. Both moderate and conservative Republican senators have expressed deep reservations about the bill, and it is expected to undergo significant revisions before it receives a vote in the Senate on or before July 4—the tentative deadline set by Senate leaders.
Currently, multiple Senate workgroups are drafting proposed changes, which could be released for review any day. Meanwhile, negotiations in the Senate are ongoing as Republicans can lose only two votes and still pass a bill under a process known as reconciliation.
The AHCA passed in the House 217-213 on May 4 following the addition of the MacArthur and Upton Amendments. The MacArthur Amendment allows states to apply for waivers for essential health benefits as they are defined under the Affordable Care Act (ACA), the age-rating ratio as defined under the AHCA and the community rating provision. The Upton Amendment allocates an additional $8 billion to the AHCA Patient and State Stability Fund (PSSF) for 2018-2023 to cover patients with pre-existing conditions.
The House bill would repeal Medicaid expansion effective in 2020, but keeps in place the shift to a per capita funding mechanism for Medicaid, with a state option to pursue a block grant for Medicaid. It also maintains patient protections included in the ACA at the federal level, but the introduction of a mechanism for waivers created under the MacArthur Amendment could weaken their overall effectiveness. According to the Congressional Budget Office, should a state choose to apply for a waiver, particularly from the community rating provisions, premiums would rise over time to a point where “people who are less healthy…would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law.”
Back to June 8, 2017 Medigram