House Reps Add Amendments to the American Health Care Act
New American Health Care Act amendments would affect Medicaid funding, eliminate Medicaid expansion, and allow states to implement work requirements.
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By - House Republicans recently added 21 pages of updates and changes to the American Health Care Act (AHCA) to push forward the potential Affordable Care Act (ACA) repeal and replace bill.
Many of the legislation’s changes would make modify the Medicaid program, including increasing state flexibility to fund Medicaid programs, immediately stopping new Medicaid expansion projects, offering states the option to require some adults to work in order to receive Medicaid, and the creation of the American Health Care Implementation Fund.
The House representatives unveiled the AHCA changes to make the potential ACA repeal and replace bill more appealing to other lawmakers.
But the amendments do not completely redraft some of the more controversial parts of the AHCA, such as proposed Medicaid funding cuts and a potential Medicaid expansion elimination.
If the AHCA passes, the Congressional Budget Office recently projected that 14 million individuals would lose health insurance primarily because of steep Medicaid funding and coverage expansion cuts.
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While the most recent draft of the legislation did not address CBO concerns, representatives did provide some additional optional clauses for state Medicaid management, including shorter time periods for consumer tax relief from ACA programs and new language on how proposed block grants are to be requested and calculated.
The redrafted legislation also includes provisions that would immediately terminate the ACA’s Medicaid expansion component that allows states to extend Medicaid coverage to certain childless, non-disabled, non-pregnant, and non-elderly adults whose incomes are below 133 percent of the Federal Poverty Line (FLP).
The bill’s first draft allowed for states implement new Medicaid expansion projects until 2020.
Under the new bill’s provisions, Medicaid expansion beneficiaries enrolled prior to December 31, 2019 would receive “grandfathered” status. States would receive the enhanced matching expansion rate under current law for these enrollees if said individuals remain eligible and enrolled in the program.
By adding a new optional category to the Social Security Act, the lawmakers intend to preserve a state’s ability to cover Medicaid expansion enrollees (non-disabled, non-pregnant, non-elderly), but at the state’s regular Federal Medical Assistance Percentage (FMAP) rate.
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House Republican leaders also revised the AHCA to give states the option to require non-disabled, non-pregnant, and non-elderly adults to work or be involved in a work-related activity in order to qualify for Medicaid coverage.
The new amendment does not allow states to impose a work requirement on pregnant women, children under 19 years of age, individuals who are single parents or caretakers of a child under the age of 6, and singular caretakers of a child with a disability.
The amendment would also prevent states from denying Medicaid coverage to people under 20 years old who are married or head of their household and maintain satisfactory attendance at school or participate in education directly related to employment.
States would receive a 5 percent increase to their FMAP rate to support the implementation of a work requirement.
Additionally, the revised legislation included changes to Medicaid block grant proposals. Medicaid funding would still be based on per capita allotment.
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States can choose the populations that receive the monies from these grants, but new provisions now say states that choose the block grants would have to define eligibility conditions for individuals who are not low-income pregnant women and children in poverty.
To receive the block grants, states would have to outline the items and services, their dollar amounts, duration, and scope along with cost-sharing and care delivery methods in a report to the federal government. The HHS Secretary would approve block grant plans unless the plan is deemed incomplete or unsound.
Another AHCA amendment would decrease the target expenditure for states that receive Medicaid Disproportionate Share Hospital payments (DSHs) that are six times over the national average and require political subdivisions to contribute to medical assistance funds.
For the qualifying states, the AHCA would lower the target total medical assistance expenditures by the amount that political subdivisions are required to contribute.
Among the new amendments is the creation of the AHCA Implementation Fund within the HHS. The new fund would manage Medicaid block grants, the Patient and State Stability Fund, new tax credit modifications, and refundable tax credits for health insurance coverage.
If the revised bill passes, a $1 billion appropriation would be made to the American Health Care Implementation Fund to launch these initiatives.
The American Health Care Act stands as the current frontrunner for an ACA repeal and replace since its proposal earlier this March. The new legislation faces both praise and concern from healthcare leaders.
