Over the past few weeks, House members and the Administration have been working to identify and introduce modifications to H.R. 1628, the American Health Care Act (AHCA) that will achieve enough votes to pass the bill through the House.

The push-me-pull-you between protecting those with pre-existing conditions and better marketplace stability and risk management often leave individuals scratching their heads on the right answer to the problem.

The wait to find out what will happen is over and the American Health Care Act passes the House with a narrow margin of 217-213.

The next step is on to the Senate for their deliberation and vote. If this passes, with no changes, then it will go to the President for signature.

The significant difference between six weeks ago and today is the House Rules modification to the bill introducing the Federal Invisible Risk Sharing Program and the two recent amendments over the past few days.

The MacArthur amendment introduces:

  • The idea of risk management through a Federal Invisible Risk Sharing Program whose design allows states to manage the costs for the sickest individuals in a way that helps the individuals without asking all the healthier individuals to foot the cost.
    • The goal: to bring down the cost of insurance for all, including those with the highest need while allowing the sickest individuals to have the same coverage options, at the same costs, as healthy individuals
    • The trade-off: information on an individual’s medical history will be needed to understand how the costs for the sickest individuals will be subsidized
  • The ability to allow States to modify certain requirements of the Affordable Care Act (ACA), namely the specific coverage required and how the premiums are calculated.
    • The goal: to maintain certain protections of the ACA, such as the prohibition on using gender to set insurance premiums and allowing dependent children the option to be on their parents plan to age 26
    • The trade-off: allowing States the option of defining “essential health benefits”, i.e. what coverage needs to be in each policy, differently thereby offering more choice options, including options with less coverage

The Upton/Long amendment introduces:

  • Additional government funding beyond what is already in the AHCA and the MacArthur amendment, to help adequately fund the costs of the sickest individuals in the Federal Insurance Risk Sharing Program or State high risk pool

Stay tuned to our ACA Watch page as we observe the Senate events unfold marking the future of this potential new law.

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