The House Ways and Means and Energy and Commerce Committees March 6 introduced the American Health Care Act, which repeals significant portions of the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152) and changes the Medicaid financing structure.
The House bill includes a number of major provisions, notably it:
Repeals funding for the ACA’s Medicaid expansion beginning in 2020;
Converts Medicaid financing from its current guaranteed matching rate structure to a per capita cap model;
Repeals the individual mandate, replacing it with a provision to penalize individuals who do not maintain continuous coverage for 63 or more days over a 12-month period prior to enrollment;
Replaces the ACA’s premium tax credits with new age-based tax credits that do not vary by geography in 2020; and
Eliminates the Prevention and Public Health Fund after fiscal year (FY) 2018.
Prior to the Ways and Means and Energy and Commerce Committees’ markups, the AAMC joined six other organizations representing hospitals and health systems across the country in a March 8 joint letter to every member of the House explaining that the organization cannot support the bill as currently written. The letter states, “We are very concerned that the draft legislative proposal being considered by the House committees could lead to tremendous instability for those seeking affordable coverage. Furthermore, we are deeply concerned that the proposed Medicaid program restructuring will result in both the loss of coverage for current enrollees as well as cuts to a program that provides health care services for our most vulnerable populations, including children, the elderly and the disabled.”
After lengthy debates, both the House Energy and Commerce and Ways and Means Committees advanced their respective pieces of the legislation along party lines.
In his opening statement, Ways and Means Committee Chair Kevin Brady (R-Texas) noted, “The legislation will provide relief from Obamacare’s taxes and eliminate tax penalties associated with the individual and employer mandates…The second objective of this legislation is to empower individuals and families by providing them – not Washington – with control over their health care dollars decisions.”
Ways and Means Ranking Member Richard Neal (D-Mass.) called the legislation “not only bad policy, but bad process” in his opening statement. “This bill sabotages the Marketplaces where close to 10 million Americans today get coverage and starts a death spiral from which we will never recover…The most egregious part of the Republican plan slashes Medicaid funding to pay for tax cuts that benefit the rich.” He added, “Hospitals would face crippling debt as they face increased uncompensated care and lower reimbursement rates. In turn, this would lead to job loss in many hospitals and have a negative ripple effect in communities where hospitals are the largest employer.”
Following the conclusion of his committee’s markup, Energy and Commerce Committee Chair Greg Walden (R-Ore.) stated, “Simply put, we have a better way to deliver solutions that put patients, not bureaucrats first. We provide the American people with what they've asked for all along: greater choice, lower cost, flexibility to choose the plan that best suits their needs.”
Energy and Commerce Ranking Member Frank Pallone, Jr. (D-N.J.) expressed concern about moving forward without a hearing or analysis from the Congressional Budget Office (CBO) on the legislation during his opening statement. He questioned, “Can Republicans guarantee that the 20 million who have insurance today will continue to have health insurance under their plan? Clearly not. How many more millions of Americans will lose their health insurance as a result of this bill? Who will be covered and what will people pay for needed health care?”
The House Budget Committee is expected to consider the legislation Wednesday, March 15, likely after the CBO releases its estimate of the bill’s cost and impact on coverage. House Republican leaders then hope to move the reconciliation bill to the House floor for final passage by late March or early April.