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Posted on Jul 05, 2018

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AHCA: House Votes to Repeal and Replace the ACA


The AHCA has once again been proposed, with some amendments, and has now passed the house of representatives. What does this version of the AHCA propose to do?


The House of Representatives voted 217-213 to repeal and replace the Affordable Care Act (ACA) with a revised version of H.R. 1628, the American Health Care Act (AHCA). The measure now heads to the Senate. Reaction to the vote from the healthcare community was swift and negative.

Here are key elements of the bill:

• Ends the tax penalty against people without coverage.

• Ends the Medicaid expansion funding.

• Changes Medicaid from an open-ended program to one that gives states fixed amounts of money per person.

• Replaces the ACA's cost sharing subsidies based mostly on consumers' incomes and premium costs with tax credits that grow with age.

• Repeals extra taxes on the wealthy, insurers, drug and medical device makers.

• Consumers who let their coverage lapse for more than 63 days in a year would be charged 30% surcharges to regain insurance. This would include people with pre-existing medical conditions.

• State waivers would allow insurers to charge older customers higher premiums.

• States get $8 billion over five years to finance high-risk pools that cover those with pre-existing conditions.

• States get $130 billion over a decade to help people afford coverage.

• Keeps ACA provision that children can remain on their parents' insurance plans until age 26.

The AHCA would eliminate the taxes and mandates that financed the ACA -- including the individual and employer mandate penalty -- allow insurers to charge older adults and young people less, and replace subsidies based on need with flat tax credits based primarily on an age. Over time, the plan would repeal the Medicaid expansion and put a ceiling on the entitlement program by shifting its structure to a per-capita block grant, which would increase as enrollee size increases. The bill would also freeze federal funding for Planned Parenthood.

The original AHCA bill was scheduled for a vote on March 24, but it was pulled at the last minute by House Speaker Paul Ryan (R-Wisc.) after he determined he did not have enough votes to pass it. Since then, Republicans made several changes to their bill.

These included:

• An amendment by Rep. Tom MacArthur (R-N.J.) that would allow states to opt out of requiring insurers to cover the ACA's list of "essential health benefits"; instead, states could develop their own lists of what benefits they considered essential. The amendment also would allow states to charge more for 1 year to patients with pre-existing conditions if they have been without insurance coverage for 63 days or more.

• An amendment by Reps. Fred Upton (R-Mich.) and Billy Long (R-Mo.) that would provide states with an extra $8 billion over 5 years to set up high-risk pools to cover patients with high costs due to pre-existing conditions, in addition to the $130 billion already in the bill that states could use for that purpose.

• An amendment by Rep. Martha McSally (R-Ariz.) to prevent members of Congress from being exempted from the AHCA. The AHCA originally exempted Congress members from being affected by state waivers.



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