Top 10 highlights in new AHCA bill -AND- Fate of Obamacare now is in the Senate

CAL/AAEM News Service at
Fri May 12 11:15:48 PDT 2017



May 4, 2017


Top 10 highlights in new AHCA bill 



mpaign=financedaily> Modern Healthcare



House Republicans plan to vote Thursday on a revised bill that seeks to
eliminate provisions of the Affordable Care Act. The nonpartisan
Congressional Budget Office estimates that the legislation will result in 24
million people losing their health insurance by 2026.


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 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 by as much as they'd like.

==> 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. 




May 4, 2017


Fate of Obamacare now is in the Senate 



ontent=51579821> Modern Healthcare



By Mara Lee


The House Republicans passed the American Health Care Act with a slim
majority on Thursday. The bill gives states the option of returning to a
pre-Obamacare individual insurance approach of medical underwriting and
high-risk pools.


The bill passed by a vote of 217-213 in the U.S. House of Representatives on
Thursday afternoon, one vote over the 216-majority threshold. It is the
GOP's first successful attempt to move legislation to repeal President
Barack Obama's signature healthcare reform bill, the Affordable Care Act,
during the Trump administration after two false starts. If it passes the
Senate, the AHCA will make stark changes to the rules and regulations
governing the healthcare industry for the last seven years.


"We can continue with the status quo under Obamacare. We know what that
looks like," House Speaker Paul Ryan said during debate on the AHCA Thursday
afternoon. "It means even higher premiums. Even fewer choices. Even more
insurers pulling out. Even more uncertainty and chaos."


"We can put this collapsing law behind us," he added. "End this failed


Although the latest tweaks to the bill revolved around treatment of
high-cost customers on the exchanges in an effort to win moderate votes, the
ACHA's biggest impact is effectively ending the Medicaid expansion after
2020. The majority of people who have gained coverage under the ACA have
obtained it through Medicaid-about 14.5 million people nationally-including
5 million who already qualified for the government health insurance but
hadn't previously applied for it.


"Rural hospitals will close, two million jobs will be destroyed across
America, and all of this to give a massive tax cut to the richest in
America," House Minority Leader Nancy Pelosi said. "It's Robin Hood in


The bill would not allow expansion-eligible people who left Medicaid, even
for just over a month, to return to the program. That could impact many
potential Medicaid beneficiaries who work intermittently, have seasonal or
part-time jobs, and cycle in and out of Medicaid as they gain or lose
employer coverage or cross the earnings limit. In Connecticut, 30% of
exchange customers came from or go to Medicaid in the course of a year.
National studies of churn have estimated it at 25% annually.


And starting in 2020, states would have to pay for their full share of
covering the expansion population. For some states, that would be a shift
from 90% funding to 50% funding. Even in Kentucky, it would be an increase
in state responsibility of almost 20 percentage points.


In Ohio, where 700,000 people have gained coverage in the expansion, the
state would have to shoulder an additional $2.2 billion if that many people
were still on the rolls in 2020.


Where will that money come from? In this year's budget proposal, Ohio
already plans to cut Medicaid rates for nursing homes and hospitals,
according to the Columbus Dispatch, because of the uncertainties around ACA
repeal. Over the next two years alone, Ohio hospitals would have more than
an 8% cut, or $588 million.


The seismic effect of reduced matches for the newly eligible doesn't include
the impact of a per-capita cap on Medicaid. Overall, the Congressional
Budget Office estimated that the bill would reduce federal spending on
Medicaid by $880 billion across nine years, starting in 2017. The CBO
analysis was of a previous iteration of the bill, but the new versions
haven't changed the effects to Medicaid. The office also said the bill would
cause 24 million people to lose their healthcare coverage.


American Medical Association President Dr. Andrew Gurman said in a statement
Wednesday that none of the amendments to the American Health Care Act would
curb the "serious harm" the bill poses to patients and the healthcare
delivery system.


"Proposed changes to the bill tinker at the edges without remedying the
fundamental failing of the bill-that millions of Americans will lose their
health insurance as a direct result of this proposal," he said.


The tweaks to the bill also didn't alter the less generous subsidy structure
for older exchange customers, particularly in markets where insurance is
more costly.


There's a lot of fury around the country over the conservative healthcare
reform bill, which has been expressed at Congress members' town halls and in
protests. A number of Republican senators whose votes are needed for a
replacement bill have said that the House version will not survive in their


First, there are procedural issues on whether the state-waiver plan can be
included and still qualify for a 51-vote majority.


A number of Republican senators also have ideas of how to improve the bill.


Sen. John Thune (R-S.D.) told Axios that he'd like to preserve income- and
age-based subsidies for customers below 250% of poverty.


Sen. Rob Portman (R-Ohio) has talked about a rolling phaseout to smooth the
transition of repealing the Medicaid expansion. However, his office declined
to provide details on his plan.




Jeff Wells
Deputy Editor, CAL/AAEM News Service


Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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