House Republicans and the White House have finalized a new draft amendment for the American Health Care Act (AHCA), American Health Line reported on Wednesday. The deal, which Republican leaders hope could revitalize the AHCA, was developed by the co-chair of the moderate “Tuesday Group,” Rep. Tom MacArthur (R-N.J.); chair of the conservative House Freedom Caucus, Rep. Mark Meadows (R-N.C.); and Vice President Mike Pence.

The draft includes several waivers that would allow insurers to charge older adults more for coverage, charge more to some beneficiaries with pre-existing conditions, and alter the Essential Health Benefits (EHB) requirements of the Affordable Care Act (ACA). It is unclear whether such waivers would allow insurers to set an age ratio “higher” than the AHCA’s 5-to-1 ratio or the ACA’s 3-to-1 ratio. States would be able to apply for the waiver on or after Jan. 1, 2018.

The revised proposal also would allow states to apply for a waiver to opt out of the AHCA’s provision that would impose a 30-percent premium penalty on individuals who do not maintain continuous coverage. Instead, insurers would be allowed to impose health status underwriting on individuals who allow their coverage to lapse for at least 63 days. However, insurers would not be able to charge more for coverage based on gender. Moreover, states that opt to waive the ACA’s community rating requirements would be required to participate in the AHCA’s Patient and State Stability Fund, which provides states with grants to pursue cost-controlling measures, such as creating high-risk pools or establishing state-based cost-sharing reductions.

The proposal also would allow states to apply for waivers to set their own EHB for plans in the individual and small group markets rather than adhere to the benefits provided for by the ACA. The waiver could allow states to define the types of drugs covered, as well as out-of-pocket spending limits and lifetime or annual spending caps. States would be able to apply for the EHB waiver on or after Jan. 1, 2020.

In order to qualify for a waiver, states would need to demonstrate that their proposal would do at least one of the following: increase enrollment in coverage; increase health plan competition; reduce average premiums; stabilize the insurance market; or stabilize premiums for individuals with pre-existing coverage. The Congressional Budget Office (CBO) has yet to release new budget projections for the draft amendment.

The next steps for the bill remain unclear. However, House Republican leaders were unable to secure enough votes to bring a health care bill to the floor this week.

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