Rep. Tom MacArthur (R-N.J.) April 25 introduced an amendment to the American Health Care Act (AHCA, H.R. 1628), legislation that repeals significant portions of the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152) and changes the Medicaid financing structure [see Washington Highlights, March 10]. Following an unsuccessful effort to pass the AHCA in March, the amendment is aimed at addressing concerns from various Republican groups, including the conservative House Freedom Caucus and the moderate Tuesday Group.
The amendment would allow states to apply for three different waivers:
First, states could apply to set a “higher” age ratio – it is unclear whether states would be permitted to set a ratio higher than the 3:1 provided for under the ACA or the 5:1 ratio provided for under the AHCA;
Second, states could apply to specify their own set of essential health benefits. This would include states determining the categories and specific benefits included within each category; and
Third, states could engage in their own health status underwriting under certain conditions.
These waivers are deemed automatically approved by the Department of Health and Human Services (HHS) unless, within 60 days, the HHS Secretary acts to disapprove the waiver. The amendment also prohibits gender underwriting and the exclusion of individuals with pre-existing conditions.
The House Freedom Caucus April 26 issued a statement in support of the AHCA as amended, stating in part, “The MacArthur amendment will grant states the ability to repeal cost driving aspects of Obamacare left in place under the original AHCA. While the revised version still does not fully repeal Obamacare, we are prepared to support it to keep our promise to the American people to lower healthcare costs. We look forward to working with our Senate colleagues to improve the bill. Our work will continue until we fully repeal Obamacare.”
It remains unclear if the Freedom Caucus endorsement provides the necessary votes to pass the underlying legislation. However, after reading about the amendment, Tuesday Group co-chair Rep. Charlie Dent (R-Pa.), stated, “Based on what I've read, it does not change my position. I was a no, and I remain a no.”
House Democrats remain unified in opposition to the AHCA and the MacArthur amendment. In an April 26 statement about the legislation, House Minority Whip Steny Hoyer (D-Md.) noted, “This latest change would still allow discrimination against Americans with pre-existing conditions, making it substantially the same bill that House Republican leaders could not secure the votes to pass last month...Bringing their catastrophic bill back, repackaged but unchanged, will not make it any more likely to pass; nor will it make it any less dangerous to the health of the American people.”
There is currently no vote scheduled on the amendment. Several members have stated they will not vote on it until the Congressional Budget Office releases an updated cost and impact analysis.