On March 6, 2017, Republicans in the House of Representatives unveiled two bills that aim to repeal and replace the 2010 Patient Protection and Affordable Care Act (ACA). The bills, collectively called the American Health Care Act, were introduced by the Ways and Means and Energy and Commerce committees, and both committees have since passed the legislation.
The much-anticipated Republican ACA replacement would dismantle many of the healthcare reforms put in place over the past seven years, including the individual mandate and Medicaid expansion.
Key provisions of the bills include:
- Repeal of the Medicaid expansion by making it optional for states.
- Elimination of the ACA’s individual mandate requiring health insurance coverage. Instead, a continuous coverage requirement would allow health insurers to charge a 30% late-enrollment surcharge to any applicant who went longer than 63 days without continuous health insurance coverage during a 12-month look back period.
- Creation of a per capita cap on federal Medicaid starting in fiscal year 2020.
- Elimination of the penalties associated with the employer responsibility provisions under the ACA.
- Elimination of the ACA’s premium tax credits and cost sharing subsidies by 2020, and creation of new age-based credits beginning in 2020.
- Elimination of numerous ACA tax provisions and delay of the effective date for the tax on “Cadillac” plans until 2025.
- $10 billion of safety net funding over the next five years to states that did not expand Medicaid.
- Requirement that states with Medicaid expansion populations re-determine expansion enrollees’ eligibility every six months and a temporary 5% FMAP increase to states as an incentive.
- A one-year freeze on mandatory funding to nonprofit essential community providers primarily engaged in family planning and reproductive health services that provide abortions in cases that do not meet the Hyde Amendment exception for federal payment and received over $350 million in federal and state Medicaid dollars in fiscal year 2014.
- Creation of the Patient and State Stability Fund, which is intended to lower patient costs and stabilize state markets. States may use the funds to:
- Provide financial assistance to high-risk individuals who do not have access to health insurance through an employer to enroll in the individual market.
- Provide incentives to certain entities to help stabilize health insurance premiums.
- Reduce costs of providing health insurance coverage in the individual market and small group market.
- Promote participation in the individual market and small group market and increase health insurance options available through each.
- Promote access to preventive services, dental care services, vision care services, mental health services, and substance use disorder services.
- Provide payments (directly or indirectly) to healthcare providers for provision of certain healthcare services.
- Provide assistance to reduce out-of-pocket costs, such as copayments, coinsurance, premiums and deductibles.
- Repeal of certain Medicaid provisions regarding presumptive eligibility determination and income eligibility levels for poverty-related children.
- Elimination of the ACA’s small business tax credit beginning in 2020.
- Elimination of the Medicaid Disproportional Share Hospital (DSH) cuts for non-expansion states in 2018 and elimination of the cuts for expansion states in 2020.
- Repeal of the cost-sharing subsidy program designed to lower out-of-pocket costs for certain plans purchased through an exchange under the ACA.
- Repeal of the ACA actuarial value standards used to determine plan tier labeling (Bronze, Silver, Gold and Platinum) to allow for more flexibility in benefit plan design.
- Modification of the permissible age variation in health insurance premiums to a ratio of 5 to 1 with states permitted to set their own ratios.
- Increases in funding for the Community Health Center Fund, which awards grants to Federal Qualified Health Centers (FQHCs).
- Repeal of the Prevention and Public Health Fund annual appropriations for prevention, wellness and public health initiatives starting fiscal year 2019.
As House Republicans work to undo major parts of the ACA, at least three central provisions of the 2010 healthcare law would remain intact: the ban on lifetime coverage caps, the provision allowing individuals to remain on their parents’ health plans until age 26, and the prohibition on denying coverage for pre-existing conditions.