On May 4, the House approved, 217-213, H.R. 1628, the American Health Care Act (AHCA). The Budget, Energy and Commerce, and Ways and Means Committees approved various portions of the measure in March (see The Source, 3/10/17 and 3/17/17). The House had planned to vote on the proposal later in March, but the House leadership was forced to cancel the vote when it became clear that there were not enough votes for passage (see The Source, 3/24/17).
The bill would repeal the Patient Protection and Affordable Care Act (ACA), commonly known as Obamacare (P.L. 111-148 and P.L. 111-152).
Following its withdrawal from floor consideration, the bill was amended to garner additional Republican support. As amended, the bill would allow states to apply for waivers that would allow insurers to charge people with preexisting conditions higher premiums if they have gaps in their coverage. The legislation would allocate $8 billion over five years to provide assistance in reducing premiums or other out-of-pocket costs in states that are granted the waivers.
Under current law, insurance plans are required to cover ten benefits, including maternity care and preventive and wellness care. Under the proposal, however, states could choose to establish their own essential health benefits or drop any requirements altogether, beginning in 2020.
The AHCA would roll back provisions in the ACA to expand Medicaid coverage to individuals whose incomes are up to 133 percent of the federal poverty line. Instead, states would receive a per capita allocation for pregnant women, the elderly, blind and disabled individuals, children, and those who previously had been enrolled in Medicaid expansion programs. States also could opt for a block grant instead of the per capita allotment. Among other provisions, the bill would permit states to impose work requirements for adults receiving Medicaid coverage. Such requirements would not apply to women for 60 days after a pregnancy, those under the age of 18, single caretakers of young or disabled children, and married individuals younger than 20 who are in school.
H.R. 1628 would provide $100 billion in mandatory funding through 2026 for a newly established Patient and State Stability Fund. These funds would be used to help states cover the costs of uninsured low-income residents and insurance issuers. In addition, the measure would provide $15 billion in 2020 for maternity care and mental health and substance abuse treatment. States that did not expand their Medicaid programs under the ACA would be eligible to receive a share of $10 billion over five years.
