On May 4 2017 the US House of Representatives passed the American Health Care Act seven years after Republicans pledged to repeal the Affordable Care Act. Twenty Republicans voted no on the legislation. At present, the Congressional Budget Office has not issued a score for the House of Representatives-passed version of the American Health Care Act.

The legislation underwent a number of amendments over the Easter recess and the days leading up to the May 4 vote, including changes negotiated by Vice President Mike Pence, House Freedom Caucus Chairman Mark Meadows and House Tuesday Group Member Tom MacArthur. The so-called 'MacArthur Amendment' would allow states to seek waivers from the Affordable Care Act's:

  • essential health benefit requirement;
  • age rating requirement; and
  • community rating rules for individuals who fail to maintain continuous coverage.

For states that pursue, secure and implement waivers, the result could be non-coverage of benefits included in the essential health benefits package (eg, prescription drugs, maternal and newborn care, treatment for mental health conditions and habilitative and rehabilitative care). It could also lead to increased costs and reduced protections for older citizens and individuals with pre-existing conditions who do not maintain continuous coverage.

The legislation now heads to the Senate, where lawmakers are expected to redraft significant portions of the bill to meet the chamber's procedural rules. Some senators have suggested their preference to write a new bill, rather than working to amend the American Health Care Act. Republican leaders can lose no more than two votes in the Senate if they hope to pass the legislation under the budget reconciliation process, which requires 51 votes to pass the Senate, but can be used only for legislation that directly affects the federal budget.

For further information on this topic please contact Stephanie P Hales, Dora Hughes or Laura R Cohen at Sidley Austin LLP by telephone (+1 202 736 8000) or email ([email protected], [email protected] or [email protected]). The Sidley Austin LLP website can be accessed at www.sidley.com.