Policy and Regulation News

House GOP Renewing Interest in American Health Care Act

A new amendment to the American Health Care Act add marginal vitality to the pulled GOP-endorsed bill.

AHCA still on the table following a GOP amendment

Source: Thinkstock

By Thomas Beaton

- House Republicans are attempting to keep the American Health Care Act (AHCA) viable by adding a new amendment to the bill prior to Congress taking its spring recess.

GOP lawmakers submitted an amendment to the House of Ways and Means Committee that creates an invisible risk-sharing program as part of the AHCA’s Patient and State Stability Fund (PSSF) program.  

Last month, AHCA was at the center of a turbulent legislative process. Starting in early March, GOP lawmakers proposed the bill which shortly met with stakeholder concern. These concerns include the loss of coverage for 26 million Americans.

Following those concerns, lawmakers added new amendments to the AHCA in an effort to force a House vote. However, the amendments were insufficient to garnering votes or easing stakeholder concerns, and the AHCA was pulled before a vote could take place.

In a last-ditch effort to new interest in the bill, GOP lawmakers have added the new risk-sharing program. The House is back in session on April 25th where the newly amended AHCA’s risk-sharing program will be reviewed.

An invisible risk-sharing program would set aside appropriated funds to be used in covering remaining care costs where an insurer’s premiums are unable to do so. These programs are designed to lower premium costs without sacrificing the quality of payer coverage.

The amendment would allocate $15 billion within the PSSF and HHS would then carry out the invisible risk sharing program by providing payments to health insurers to claims for eligible individuals with the purpose of lowering premiums.

Other unallocated funds within the PSSF are also to be used to help carry out the program.

On an operational level, HHS would consult with healthcare consumers, health insurance issuers, state insurance commissioners, and stakeholders to determine the highest healthcare costs that need assistance.

Individuals who would qualify for the program would be divided into two groups, automatic and voluntary qualification.

If a person has health conditions that automatically qualify them for the program, then she can receive health insurance coverage under automatic qualification.

Under voluntary qualification, health insurers can decide whether a person should receive coverage under the risk-sharing program if the person does not have qualifying health conditions.

If enacted, the risk sharing program would go into effect on Jan 1, 2018 and end on December 31, 2026. While the program would be finalized in 2018, states would be required to comply by the year 2020.

The risk-sharing program does not affect the major provisions of the bill that cut spending and funding for federal healthcare programs.

Most notably of these is the provision within the AHCA that includes state limits on Medicaid, which would cut Medicaid expansion for several beneficiaries of the program.

In a later amendment, Medicaid eligibility would be heavily restricted through work, employment, and caretaker verification requirements.  

Other state Medicaid funding programs, such as proposed block grants, also have requirements for eligibility.

On a consumer level, AHCA offers premium tax credits to help pay for health costs, tax and penalty relief from ACA programs, and optional Health Savings Accounts (HSA) used tax-free to help pay for healthcare coverage.