May 2017
On May 4, the House of Representatives narrowly passed, along partisan lines, the American Health Care Act (AHCA). The latest changes to the bill technically retain the Affordable Care Act's essential health benefits and community rating rules prohibiting insurers from charging people with pre-existing conditions higher premiums, however, it allows states to waive both of these requirements. The community rating rules could be waived if a state agrees to set up a high-risk pool and additionally, if the state can prove that it will expand insurance coverage or reduce insurance premiums or advance another state public benefit. The bill provides $8 billion for states that waive the community rating rules to set up high-risk pools.
The AHCA retains the bill's original provisions that the Congressional Budget Office estimated would cause up to 24 million Americans to lose insurance coverage within a decade, cap Medicaid funding to states and end the ACA's Medicaid expansion in 2020.
The ATS sent a letter to all House Representatives urging a "NO" vote on the ACHA. In the letter, ATS President David Gozal, MD, MBA, states, "We are concerned that the latest changes to the legislation are not sufficient to ensure insurance coverage for patients with expensive chronic conditions. Reliance on "high risk pools" will not adequately meet the health insurance needs of many Americans with pre-existing conditions." Dr. Gozal continued, "We remain concerned that allowing states to waive the ACA's essential health benefits, which include chronic disease management services that are vital for people with respiratory conditions such as asthma and COPD, will lead to reduced coverage for many Americans."
Action on the ACA repeal and replace effort now turns to the Senate. Significant changes will be made to the ACHA as several Republican senators have publicly expressed opposition to some of the bill's provisions, such as the funding reductions to the Medicaid program. The ATS Washington Office will keep members informed as the bill moves through the legislative process.
