The American Health Care Act (AHCA), the House Republicans’ ACA “repeal and replace” bill, was introduced in early March. The Congressional Budget Office (CBO) estimated that under the AHCA, 14 million people would lose coverage in 2018 and 24 million by 2026.   It would also reduce the federal deficit by $337 billion over the period 2017-2026. Further, CBO says that the AHCA “would tend to increase average premiums in the non-group market prior to 2020 and lower average premiums thereafter, relative to projections under current law. Although average premiums would increase prior to 2020 and decrease starting in 2020…changes in premiums relative to those under current law would differ significantly for people of different ages because of a change in age-rating rules. Under the legislation, insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law, substantially reducing premiums for young adults and substantially raising premiums for older people.”

A scheduled House vote in late March on the AHCA was canceled because there were not enough votes to pass the legislation. Congress left Washington for two weeks starting April 10 for a district work period—during which many members held town hall meetings on health care reform. During this work period, another version of the AHCA was negotiated by Rep. Mark Meadows (R-NC) of the conservative House Freedom Caucus, and Rep. Tom MacArthur (R-NJ), of the moderate Republican Tuesday Group that would give more flexibility to states.  While most members of the Freedom Caucus have endorsed this newly amended version of the AHCA, many in the more moderate wing of the House Republican caucus have expressed concerns with it. 

Two main changes to the AHCA are:

  1. Inclusion of a provision that allows states to waive the federal rule prohibiting insurers from increasing premiums for individuals with pre-existing conditions. In order for a state to waive the rule, the state would have to apply for a waiver and create a high-risk pool.
  2. Inclusion of the essential health benefits (EHB), with the caveat that states could receive a waiver if they were able to show that waiving EHB would lower premiums, increase participation, or “advance another benefit to the public interest in the state.”

Republican leadership in the House may bring up this revised bill for a vote the week of May 1. It continues to be unclear if there are enough votes to pass the legislation.