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ACA Watch 2017: Congressional Break Concludes, AHCA Is Alive and Well

American Health Care Act (AHCA) – Take 2

On Tuesday, April 25, Congress will resume and may well vote again on the American Health Care Act (AHCA) in the next week or so. That is, if they finalize funding to avoid a government shutdown that will otherwise take place on Saturday, April 29.

The introduction of a new amendment, providing a “Federal Invisible Risk Sharing Program” from April 6 is the starting place for the next rendition of the bill. This new program manages the risk and cost of the sickest individuals without loss of coverage options or higher premium to the individual. It includes government subsidization to those incurring the highest medical expenses.

A new amendment brought forward by Tom MacArthur (R-NJ), leader of the Tuesday Group, and Mark Meadows (R-NC), leader of the Freedom Caucus is up for discussion and may lead to more favorable support. The Congressional Budget Office (CBO) will still need to score the bill with the new amendment. We should be able to see the actual amendment and CBO scoring this week.

The Issues in Debate

  • The preservation of certain Affordable Care Act (ACA) provisions originally tagged for elimination or modification in the first version of the AHCA:
    • The Essential Health Benefits
    • Prohibition on denying coverage due to preexisting medical conditions;
    • Community rating that allows rates to be based solely on age, geographic region, and make-up of family, i.e. not gender or health conditions (individual and small group markets);
    • Guaranteed issue and renewability of coverage to all applicants and participants;
    • Dependent coverage up to age 26, and
    • Limited waivers (section 1332 waivers) – these allow States to be exempt from ACA standards if they can maintain or improve the amount of coverage, number of people insured, and premium costs
  • The expansion of Limited Waivers to allow States the option to eliminate or modify:
    • Essential Health Benefits
    • Some of the community rating rules, except for the following non-waivable categories:
      • Increasing the premium ratios from 3:1 to 5:1 (ratios represent the premium spread from the youngest person to the oldest person)
      • Introducing health status back into the rating if the State has establishes a high risk pool or participates in the Federal Invisible Risk Sharing Program

Moving healthcare reform forward is a major goal for President Trump as he approaches the end of the first 100 days in office at the end of April. House Speaker Paul Ryan feels that they are in the final stages of negotiation on this bill, including a review by the Senate to make sure the provisions will pass. According to top White House officials, they will take the time they need to “get it done right.” Speaker Ryan is saying they won’t go to a vote unless the GOP whips are confident they have enough votes to pass the bill.

Stay tuned to our ACA Watch 2017 page as OneDigital continues to interpret what’s happening in Washington, embracing this change head-on for our clients.