Affordable Care Act Repeal Proposal Unveiled
The long-anticipated legislation to repeal and replace the Affordable Care Act’s (ACA) core features was unveiled on March 6. Dubbed the American Health Care Act, the replacement legislation was introduced via a pair of bills released by the Energy and Commerce Committee and the Ways and Means Committee in response to the instructions they received in the Budget Resolution passed by both houses of Congress to prepare budget reconciliation legislation to repeal the ACA.
As seen in a summary of the American Health Care Act released by the Kaiser Family Foundation, key provisions of the bills include:
- Repeal ACA mandates (2016), standards for health plan actuarial values (2020), and, premium and cost sharing subsidies (2020).
- Modify ACA premium tax credits for 2018-2019 to increase amount for younger adults and reduce for older adults, also to apply to coverage sold outside of exchanges and to catastrophic policies. In 2020, replace ACA income-based tax credits with flat tax credits adjusted for age. Eligibility for new tax credits phases out at income levels between $75,000 and $115,000
- Retain private market rules, including requirement to guarantee issue coverage, prohibition on discriminatory premiums and pre-existing condition exclusions, requirement to extend dependent coverage to age 26. Modify age rating limit to permit variation of 5:1, unless states adopt different ratios.
- Retain health insurance marketplaces, annual Open Enrollment periods (OE), and special enrollment periods (SEPs).
- Impose late enrollment penalty for people who don’t stay continuously covered.
- Establish State Innovation Grants and Stability Program with federal funding of $100 billion over 9 years. States may use funds to provide financial help to high-risk individuals, promote access to preventive services, provide cost sharing subsidies, and for other purposes. In states that don’t successfully apply for grants, funds will be used for reinsurance program
- Repeal funding for Prevention and Public Health Fund at the end of Fiscal Year 2018 and rescind any unobligated funds remaining at the end of FY2018. Provide supplemental funding for community health centers of $422 million for FY 2017
- Encourage use of Health Savings Accounts by increasing annual tax free contribution limit and through other changes
- Eliminate enhanced FMAP for Medicaid expansion as of January 1, 2020 except for those enrolled as of December 31, 2019 who do not have a break in eligibility of more than 1 month
- Convert federal Medicaid funding to a per capita allotment and limit growth beginning in 2020 using 2016 as a base year
- No change to Medicare benefit enhancements or provider/Medicare Advantage plan payment savings
- Repeal Medicare HI tax increase and other ACA revenue provisions
- Prohibit federal Medicaid funding for Planned Parenthood clinics
Accompanying the proposal summary, Kaiser also published an interactive chart where the seven proposals to replace the ACA can be compared side-by-side and also updated its interactive maps that compare county-level estimates of premium tax credits consumers.
For full details, see the Energy and Commerce Committee’s Section-By-Section Summary (pdf) and the Congressional Budget Office’s Cost Estimate (pdf).