May 2017 ~

On May 4, the House of Representatives passed the American Health Care Act (AHCA) (H.R. 1628) by a 217 to 213 vote. With a total of 216 yes votes were needed to pass the bill, the vote passed by a narrow margin.

An earlier version of the AHCA came up for a vote in March, but the decision was made to pull the bill from the floor because in fear that it would not pass at that time. Following this, revisions were made to the legislation to incorporate four amendments:

1. The MacArthur amendment(introduced by Congressman Tom MacArthur) allows states the option to apply for waivers from the federal government to rescind some Affordable Care Act (ACA) regulations if they can prove it would reduce the costs for residents.
2. The Upton amendment(introduced by Congressman Fred Upton) would allocate an additional $8 billion over five years (2018 to 2023) to states that receive waivers for additional funding for their programs to pay the continuous coverage penalties imposed on individuals with pre-existing conditions by the MacArthur Amendment.
3. The Palmer-Schweikert amendment(introduced by Congressman Gary Palmer and Congressman David Schweikert) – adds $15 billion for invisible high risk pools (analogous to reinsurance)
4. The McSally amendment(introduced by Congressman Martha McSally) – adds $15 billion for maternity and mental/behavioral health care.

The final AHCA as passed combined the original bill with all the subsequent amendments:

• Eliminates the taxes and tax increases imposed by the ACA;
• Phases out enhanced funding for the Medicaid expansions and imposes either a block grant or per capita caps on Medicaid;
• Removes the individual and employer mandate penalties:
• Increases age rating ratios from 1 to 3 to 1 to 5 in the individual and small group market and allows states to go higher by waiver;
• Permits states to waive the ACA’s essential health benefit requirements;
• Imposes a penalty on individuals who do not maintain continuous coverage.
• Alternatively allows states to obtain a waiver to allow insurers to health status underwrite individuals who do not maintain continuous coverage.
• Creates funds of $138 billion to assist states in dealing with high-cost consumers and for other purposes
• Ends the ACA’s means tested subsidies as of 2020 and substitutes for them age-adjusted fixed-dollar tax credits.

The bill will next move on to the Senate.

The Radiology Business Management Association (RBMA) predicts “the AHCA as currently written faces dismal prospects in the Senate, where Republicans can only afford to lose votes from two GOP senators while passing the bill – a challenging prospect given the range of concerns expressed by both moderates and conservatives in the upper chamber. It is likely to be substantially changed because of policy and reconciliation considerations, a process likely to take months. Furthermore, a CBO score is a prerequisite to Senate consideration – generally expected next week – and could further inform debate.”

The first version of the AHCA was scored by the nonpartisan Congressional Budget Office (CBO) to estimate how many people it would cover and how much it would cost, but the latest version of the bill has not yet been scored.

Prior to the amendments offered in recent weeks, the CBO projected the AHCA would reduce the federal deficit by $150 billion and reduce health insurance coverage by 24 million by 2026. In this estimate, the CBO stated fourteen million people would lose coverage within the first year.

 

Source(s): Modern Healthcare; Modern Healthcare; HealthcareDIVE; RBMA e-Alert; MGMA Washington Connection – Special Alert; The New York Times; Becker’s Hospital Review;