From Professor Jost's post on Health Affairs Blog, reprinted with permission:

On May 4, 2017 the House of Representatives passed the American Health Care Act (AHCA) by a near party-line vote of 217 to 213. The AHCA was first introduced in the House on March 6, 2017, in response to the long-standing promise by Republican members of Congress to repeal the Affordable Care Act.

The AHCA, however, does not repeal the ACA. It does not touch the provisions of six of the ACA’s ten titles dealing with Medicare payment, quality, and care delivery reforms; fraud and abuse; workforce reform; biosimilars; prevention; or many other issues. The original AHCA did not even address many of the ACA’s core insurance reforms. It did not, for example, modify the ACA’s requirements that health plans cover preexisting conditions; guarantee availability and renewability of coverage; cover adult children up to age 26; and cap out-of-pocket expenditures. Neither did it repeal the ACA’s prohibitions against health status underwriting, lifetime and annual limits; and discrimination on the basis of race, nationality, disability, age, or sex. It left perhaps 90 percent or more of the provisions of the original ACA in place. ...

AHCA As Passed By The House

The final AHCA as passed [by the House] combined the original bill with all the subsequent amendments. In sum it:

• 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; [and]
• Ends the ACA’s means tested subsidies as of 2020 and substitutes for them age-adjusted fixed-dollar tax credits.

What’s Next?

The bill now moves to the Senate where it faces a very uncertain future. The Republicans can afford to lose at most two votes in the Senate, and both conservative and moderate Republicans have concerns about the legislation. Moreover, to pass without Democratic support the legislation will have to meet strict budget reconciliation rules, and a number of the provisions do not obviously comply. Finally, the CBO has not yet scored the bill, and a score, which is likely to find dramatic increases in the uninsured, may raise further questions about the legislation.


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