On Thursday House Republicans passed their bill, the American Health Care Act, to repeal and replace key parts of the Affordable Care Act by a vote of 217-213, capping weeks of negotiations.
After the AHCA was pulled before the House could vote on it in March, two amendments were added to secure votes from both the conservative and moderate wing of the GOP. First, the MacArthur amendment, introduced by Rep. Tom MacArthur (R-N.J.), co-chair of the moderate “Tuesday Group,” was added to allow states to apply for waivers from the federal government to rescind some Obamacare regulations if they can prove it would reduce the costs for people in their states.
The second amendment was the Upton amendment, introduced by Rep. Fred Upton (R-MI). It allocates an additional $8 billion over five years to states that receive waivers for additional funding for their own programs, and $130 billion over 10 years was earmarked for the fund. While Upton said it was designed to help bring down costs for those with preexisting conditions, the amendment does not specify that the money be used for those people. Instead, it says the funds are to be used to “reduce premiums or other out-of-pocket costs of individuals who are subject to an increase in the monthly premium rate for health insurance coverage as a result of such waiver.”
Other major provisions in the bill include gradually rolling back Medicaid expansion. Starting in 2019, states would receive an allotment of federal money for each beneficiary, or they could take the money in a lump sum as a block grant, with fewer federal requirements. Medicaid cuts would total $880 billion over 10 years.
The bill encourages people to maintain “continuous coverage.” If coverage is interrupted for more than 63 days, insurers can charge people a 30-percent penalty over their premium for one year.
Also, the bill repeals nearly all of the taxes in the Affordable Care Act. The repeal includes the tax on incomes over $200,000 (or $250,000 for a married couple); a tax on health insurers; a limit on how much insurance companies can deduct for executive pay; and the tax on medical-device manufacturers.
The legislation was passed without an assessment from the Congressional Budget Office (CBO). An assessment of an earlier version of the AHCA estimated that as many as 24 million more people could go without coverage. The bill will now go to the Senate, where it faces an uncertain future. Many of the bill’s most controversial provisions could be dropped, as Senate Republicans have signaled little interest in the House version of the bill.
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