May 4, 2017 — The U.S. House of Representatives on Thursday narrowly approved the American Health Care Act, the legislation designed by House Republican leadership and backed by President Donald Trump to replace the Affordable Care Act (ACA), also known as Obamacare.
The AHCA eliminates many of the mandates on individual and employer insurance plans put forth by the ACA. Some of the bill’s major provisions include:
- Elimination of the ACA tax penalties on those without health insurance, and instead offering tax credits of $2,000-$4,000 per year based primarily on age. ACA tax credits were based primarily on income;
- Rollback of the Medicaid expansion enacted under the ACA. Rather than keep it as an open-ended entitlement, states would either receive an allotment of federal money for each beneficiary, or they could elect to take the funding as a block grant in one lump sum. The rollback would be gradual, with states expected to fully pay to cover their own expansion populations beginning in 2020;
- The AHCA maintains Obamacare’s ban on insurers denying coverage to those with pre-existing conditions. However, states can apply to be exempt from this measure, known as the community rating provision, to establish high-risk insurance pools for the sickest people. The initial bill set aside $130 billion in a Patient and State Stability Fund to help fund these pools, and a last-minute amendment provides an additional $8 billion over five years; and
- States can also apply for waivers on mandates requiring ACA-purchased insurance plans to include a number of minimum health benefits for preventive services such as hospitalizations, prescription drugs and maternity care.
The 217-213 vote Thursday came down mostly along party lines, with 20 Republicans breaking ranks to vote no. (The party could only afford to lose 22 votes on the legislation.) Democrats uniformly voted in the negative.
The vote was conducted before the Congressional Budget Office (CBO) could release a full analysis of the effects of the AHCA. The office’s report on the previous version of the bill estimated it would lead to an additional 24 million people losing their insurance over the ensuing decade.
Several medical societies issued statements agaist the ACA repeal and replace effort, including the American College of Cardiology (ACC). “The American College of Cardiology opposes the American Health Care Act (AHCA) in its current form, and is disappointed by its passage today in the U.S. House of Representatives," said ACC President Mary Norine Walsh, M.D., FACC. "As it stands, the AHCA would allow states to bypass existing federal protections for sick and elderly people, and potentially undermine coverage for critical services for patients with heart disease. This iteration of the AHCA is inconsistent with the ACC’s Principles for Health Reform, which reflect our belief in the importance of promoting patient access to meaningful insurance coverage and quality, cost-effective care. It is important for all members of Congress to prioritize protection for the most vulnerable Americans as health reform efforts move forward. The ACC will continue to work with lawmakers on both sides of the aisle to create solutions that maintain patient access to the coverage and care they need.”
Second Round of Repeal and Replace
The Thursday vote marked the second time Republicans had tried to pass the AHCA, after the legislation was pulled from consideration minutes before a scheduled vote in March. House Speaker Paul Ryan was forced to postpone the vote when deep divisions between the moderate and ultraconservative factions of the Republican Party made it unclear whether the bill could receive enough votes to pass.
While House Republicans celebrated the victory, the legislation is expected to face major challenges in the Senate from both parties, with revisions expected. Senate Republicans have expressed concerns about how the AHCA would affect states that took advantage of the Medicaid expansion. Some also wondered whether the bill would drive up insurance premiums for older people.
Health and Human Services Secretary Tom Price, M.D., praised the repeal-and-replace legislation. “The status quo is failing the American people. Premiums are skyrocketing; choices are narrowing or vanishing; and patients do not have access to the care they need. Today, the House of Representatives has begun to deliver on President Trump’s promise to repeal a broken law and replace it with solutions that put patients in charge. This is a victory for the American people,” he said.
Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said, “Today is the first of what I am confident will be many historic days ahead as we move toward patient-centered healthcare instead of government-centered healthcare.
“I have worked in the field of Medicaid for 20 years and have heard from many mothers like myself who have shared their struggles and their hopes for a more affordable, more sustainable healthcare system. It is important that our most vulnerable citizens, the aged, the infirm, the blind and the disabled have more choices, greater access and peace of mind when it comes to their healthcare. The bill that was passed today is a great first step achieving this goal,” she added.
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