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Late Tuesday evening, Republicans released an amendment to the American Health Care Act (AHCA), the legislation aimed at repealing and replacing the Affordable Care Act (ACA). Although the AHCA was expected to be voted on by the House of Representatives in March, the bill was ultimately withdrawn from House floor consideration after the Republican leadership and the White House determined there were not sufficient votes to pass the legislation. Opposition to the bill came from all House Democrats, as well as some conservative and moderate Republicans.
The new amendment to the AHCA was the result of negotiations among more conservative House Republicans led by Rep. Mark Meadows (R-NC), the Chair of the House Freedom Caucus, and Rep. Tom MacArthur (R-NJ), a co-Chair of the Republican moderates’ “Tuesday Group.” The latest version would allow states to opt out of the ACA’s regulations on essential health benefits— the requirement that health plans cover ten categories of essential health benefits— coverage spanning from preventative care to hospitalization. The amendment would also allow states to opt out of the community rating requirements of Obamacare, allowing health plans to charge people more based on their age and health status and also permit states to reject the continuous coverage provision initially proposed by Republicans in the AHCA.
In order for states to opt out of these regulations, the amendment notes that states would need to propose one of the following to receive a waiver from the Department of Health and Human Services (HHS):
1. Reduce average premiums for health insurance coverage
2. Increase enrollment in health insurance coverage
3. Stabilize the market in the State
4. Stabilize premiums for individuals with pre-existing conditions
5. Increase the choice of health plans in the State
A March Congressional Budget Office (CBO) analysis of the AHCA projected that enactment of the legislation would result in 24 million fewer Americans having health insurance coverage than projected under the ACA. Reports have opined that the newest amendment could further increase the number of uninsured.
It is expected that Republican leaders will discuss this amendment with their colleagues this week to see if a sufficient number of conservative and moderate Republicans will agree to vote for the amended AHCA to pass the House. There is no indication of whether a vote is in the near future or if further negotiations will take place. ASA and the Ad Hoc Committee on Health Reform will continue to track and discuss ongoing deliberations on legislation to repeal and replace the Affordable Care Act.
