The vote proceeded without an updated analysis of its cost and impact on insurance coverage from the Congressional Budget Office (CBO), which determined the earlier iteration would cause up to 24 million individuals to lose their insurance coverage by 2026. Many experts believe the bill approved by the House yesterday will cause even more individuals to lose coverage.
The House-approved AHCA would:
- Effectively eliminate federal coverage (individual and employer) mandates by reducing to zero the penalty for failure to comply with them. To eliminate these mandates completely will require future legislation;
- Repeal most taxes established by the ACA and delays “Cadillac” tax on high-cost employer-sponsored group health plans until 2025;
- Exchanges tax subsidies to help individuals purchase health insurance with refundable, advanceable tax credits of $2,000 – $4,000 (based on age);
- Maintain the 10 Essential Health Benefits (EHBs), which includes emergency services, and several other patient protections, such as coverage for individuals with pre-existing conditions, guaranteed issue and renewability, coverage of dependents on parents’ plan up to age 26, and community rating rules. However, states could easily seek waivers to eliminate EHBs and charge different rates for insurance based on the individual’s health;
- Limit enhanced federal match payments for Medicaid to states that adopted expansion as of March 1, 2017 and eliminate enhanced federal match for those states as of Jan. 1, 2020 (except for those enrolled as of Dec. 31, 2019 who do not have a break in eligibility of more than one month);
- Convert pre-ACA Medicaid into a per-capita allotment with state option to receive block grant;
- Increase incentives to utilize Health Savings Accounts (HSAs);
- Repeal ACA Prevention and Public Health Fund;
- Establish $100 billion fund to create State Innovation Grants and Stability Program to provide financial assistance to high-risk individuals, promote access to preventive services and provide cost-sharing subsidies;
- Provide $15 billion for Federal Invisible Risk Sharing Program (reinsurance) grants to states;
- Allocate $15 billion for maternity coverage and newborn care, as well as mental health and substance use disorders; and
- Make $8 billion available to help states establish high-risk pools.
ACEP opposed the legislation because it erodes the guaranteed coverage of emergency medical care by insurance plans, does not fully protect individuals with pre-existing health conditions, and is projected to cause millions of Americans to lose their insurance coverage, among other things. As ACEP President Rebecca Parker, MD, FACEP, stated in our press release: “Access to emergency medical care is critical to all Americans, as is insurance coverage for that care. This latest version of the new health care legislation does little to improve the health of the nation and will lead to more Americans not having any form of health care coverage.” Dr. Parker was also quoted in a CBS News story: “We’re pretty concerned that the AHCA passed in the House today, in particular providing the ability for states to waive essential benefits of emergency services. People can’t choose when they’re going to have an emergency and can’t worry about whether they’re going to be covered or not.”