According to the nonpartisan Congressional Budget Office cost estimate for the American Health Care Act, the AHCA would result in 14 million fewer people having health insurance in 2018, which would increase to a total of 23 million by 2026. The CBO report also estimates that the legislation would reduce the federal deficit by $119 billion over 10 years.
The version of the AHCA that passed in the U.S. House of Representatives on May 4 included two new provisions, named the MacArthur Amendment. It allows states to:
- “Opt-out” of Affordable Care Act (ACA) regulations, including a requirement that insurance companies charge the same prices to those with preexisting medical conditions as everyone else.
- Waive the requirements for essential health benefits, which covers prescription drugs, maternity care and emergency services, all of which were required under the ACA. In states choosing to waive the requirements for essential benefits, policies also may discontinue covering treatments for mental health and substance abuse.
According to the CBO, about one-sixth of the population would live in states that would opt-out from both essential health benefits and the pre-existing condition requirement. To allay concerns about coverage of people with pre-existing illnesses, House Republicans allocated in their bill an additional $8 billion over five years to help sick people pay their insurance premiums. The CBO also estimated that 50 percent of the population would live in states that would not request the waivers. In those states, the CBO said average premiums would be about 4 percent lower in 2026. In states that make moderate changes to their markets, representing about one-third of the U.S. population, premiums would fall 20 percent on average.
Other savings in the bill would result from capping federal funding to states for the Medicaid program and scaling back tax credits for individuals with low and modest incomes to pay for private insurance. The bill also would repeal nearly all the taxes imposed in the ACA to pay for the new benefits, including taxes on wealthy individuals and much of the health industry.
The GOP-controlled Senate already has indicated that it will write its own bill to repeal and replace parts of the ACA. For the last several weeks, a 13-person group of GOP senators have been working on a compromise bill.
