The American Health Care Act: A Public Policy Update

As you know, at the end of last week, the US House of Representatives passed the American Health Care Act (AHCA) with 217 votes against 213. We asked our public policy team to break it down for us. Here is the nonpartisan skinny:

Grants and Charges:

AHCA eliminates cover and cost-sharing subsidies, and hedge mandates on employers and individuals. Unlike current grants, the AHCA tax credits are not adjusted based on revenue or geographical variations of premiums. To encourage continued registration, it allows insurers to assess a 30% premium surcharge for people with coverage gaps of two months or more.

Essential Health Benefits (EHB) and Coverage Ceilings:

AHCA gives states the opportunity to establish their own EHBs – such as mental health, maternity, hospitalization and drug coverage – and set annual and lifetime coverage ceilings for reduce premiums. An interpretation of this provision is that, if a state exercised this option, it would apply to all markets (individual, employer and group policies) in all states.

The Community Rating:

AHCA allows states to obtain exemptions from "community pricing", which prevents insurers from charging more to people with pre-existing problems. Exemptions would be reserved for states that set up a high-risk pool for people with expensive conditions. AHCA provides $ 130 billion over 10 years for risk pools. It allows insurers to bill older customers for rates five times higher (prices allowed by the ACA are three times higher). Insurers may charge higher rates in states that obtain exemptions.

Medicaid Summary:

AHCA suppresses the expansion of Medicaid. States continue to obtain additional funding only for those registered before 2020; Once the individuals in the expansion population leave Medicaid, the higher funding for them stops. Starting in 2019, federal funding for Medicaid would be set annually; States could choose between caps per capita or global subsidies indexed to medical inflation. In March, the Congressional Budget Office said it would reduce Medicaid's federal spending by 25%.


AHCA eliminates a $ 1 billion prevention and public health fund, about 12% of the budget of Centers for Disease Control and Prevention.

Reproductive Health / Family Planning:

AHCA blocks Medicaid repayments at Planned Parenthood for one year. It also eliminates the use of federal tax credits to pay for insurance covering abortions.


AHCA eliminates taxes created under the ACA: on insurers, medical devices, drug manufacturers and tanning salons, as well as on people earning over $ 250,000 a year.

ACA Provisions Unchanged:

AHCA does not change the ACA's provisions on Medicare payment, quality, delivery and labor reforms and fraud and abuse.

Next step:

AHCA faces widespread opposition from the health care sector and specific patient and disease groups. It is considered unlikely to advance in the Senate, which should take at least a month (probably longer) to consider and prepare amendments for deliberation. Senate Republicans are concerned about proposed waivers for pre-existing provisions and essential benefits, the restructuring of Medicaid and the size and form of refundable tax credits. Democrats in the Senate unilaterally oppose the bill.

Although the AHCA can pass the Senate by simple majority because of the special rules for reconciliation, Republicans hold only a two-seat majority. This means that they can not afford more than three dissidents, assuming that Vice President Mike Pence would break a 50:50 tie.

Here is your update from Hill and the NCQA public policy team! Stay tuned for other developments.

 Matt Brock "class =" avatar avatar-100 wp-user-avatar wp-user-avatar-100 photo alignnone "/>

<p data-recalc-dims= Matt Brock is the Director of Communications at NCQA. After more than two decades in broadcast journalism, Matt now leads NCQA's efforts to develop unique content that engages and informs consumers and suppliers, plans and decision-makers via this blog, our website, and many social media platforms. Matt's goal is to educate consumers and direct them to the best resources when they consider the quality of their healthcare decisions.


Leave a Reply