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The rub: American Healthcare Act

The truth is, I'm not too excited about it.  There are some significant changes in here, and I think they are worth the effort to get passed.  They want to try to pass a full repeal in 3 phases:

  • The American Health Care Act, which takes full advantage of the budget reconciliation process to avoid a Democratic filibuster;
  • Administration actions, notably by HHS Secretary Price, to stabilize the health insurance market, increase choices, and lower costs; and
  • Additional legislative policies, such as allowing individuals to purchase coverage across state lines, that by Senate rules cannot be included in a reconciliation bill.

The biggest impact will not be until the second phase, cost control.  The Speaker claims this is the only way to make a positive effort for the bill to be signed into law. Otherwise, they will have political difficulty.  Crazy politics!

Just in the last week, they had to modify it to get more conservative votes to set the stage for approval by the President. There is a glimmer of hope.  Today, as they push it through, we wait and see what kind of action will be taken by our elected officials.  I'd say, let's keep the ball moving and get the cost under control and get our doctors back in our networks.  

Butch Z. 


Summary of the American Healthcare Act

Credit: kff.org


American Health Care Act 

Date plan announced March 6, 2017 

Overall approach  

• Repeal ACA mandates (2016), standards for health plan actuarial values (2020), and, premium and cost sharing subsidies (2020).   

• Modify ACA premium tax credits for 2018-2019 to increase amount for younger adults and reduce for older adults, also to apply to coverage sold outside of exchanges and to catastrophic policies.  In 2020, replace ACA income-based tax credits with flat tax credits adjusted for age.  Eligibility for new tax credits phases out at income levels between $75,000 and $115,000  

• Retain private market rules, including requirement to guarantee issue coverage, prohibition on discriminatory premiums and pre-existing condition exclusions, requirement to extend dependent coverage to age 26.  Modify age rating limit to permit variation of 5:1, unless states adopt different ratios.  

• Retain health insurance marketplaces, annual Open Enrollment periods (OE), and special enrollment periods (SEPs).   

• Impose late enrollment penalty for people who don’t stay continuously covered.   

• Establish State Innovation Grants and Stability Program with federal funding of $100 billion over 9 years.  States may use funds to provide financial help to high-risk individuals, promote access to preventive services, provide cost sharing subsidies, and for other purposes.  In states that don’t successfully apply for grants, funds will be used for reinsurance program 

• Repeal funding for Prevention and Public Health Fund at the end of Fiscal Year 2018 and rescind any unobligated funds remaining at the end of FY2018.  Provide supplemental funding for community health centers of $422 million for FY 2017 

• Encourage use of Health Savings Accounts by increasing annual tax free contribution limit and through other changes 

• Eliminate enhanced FMAP for Medicaid expansion as of January 1, 2020 except for those enrolled as of December 31, 2019 who do not have a break in eligibility of more than 1 month  

• Convert federal Medicaid funding to a per capita allotment and limit growth beginning in 2020 using 2016 as a base year 

• No change to Medicare benefit enhancements or provider/Medicare Advantage plan payment savings 

• Repeal Medicare HI tax increase and other ACA revenue provisions 

• Prohibit federal Medicaid funding for Planned Parenthood clinics