Repeal and Replacement for the Affordable Care Act

The American Health Care Act (AHCA) – the House Republicans’ legislation to repeal and replace the Affordable Care Act (ACA) – was introduced on March 8, 2017. Although the vote to pass the AHCA was scheduled for March 24, it was canceled by House Speaker Paul Ryan because there were not enough votes to ensure passage.   

There are a number of reasons why the AHCA failed to garner sufficient support among House Republicans. The conservative House Freedom Caucus opposed the bill because it did not fully repeal the ACA. More moderate Republicans did not support the bill because it cut nearly $900 billion from Medicaid; 18 million people would have lost health coverage in 2018, the first year it would have been in effect, and there would have been dramatic premium increases for people over age 50. It also cut taxes for upper income Americans by $1 trillion. There was no Democratic backing for the bill, and only 17 percent of Americans supported it. 

Although the AHCA did not pass, we expect that the issue of health care will remain a main topic on Capitol Hill and we will continue to see new bills and negotiations on how to move forward with changes to the ACA.

The American Kidney Fund supports a number of guiding principles for health care to ensure that all kidney disease patients have access to the services they need. They are located in our 2017 policy priorities located here. 

Below is an outline how the AHCA matched up to our health care principles.

Pre-existing conditions

  • AKF opposes allowing insurers to impose pre-existing condition clauses in their plans. 
  • AHCA would not have changed the current prohibition on pre-existing conditions.

Adequate premium tax credit

  • AKF supports an adequate premium tax credit to ensure that low-income and financially struggling consumers, especially patients with kidney disease, can afford health insurance plans. 
  • AHCA would have changed the premium tax credit from income-based to a universal tax credit based on age. Starting in 2020, the tax credits would have been changed to:
    • $2,000 per individual up to age 29
    • $2,500 per individual age 30-39 
    • $3,000 per individual age 40-49 
    • $3,500 per individual age 50-59 
    • $4,000 per individual age 60 and older

Essential health benefits

  • AKF supports the retention of essential health benefits (EHB). Without EHBs, insurers could create plans that do not cover services that are important to kidney patients.
  • The AHCA included language that repealed the EHB provisions of the ACA. These provisions affect all kinds of insurance including qualified health plans (QHPs) bought through the Exchange and employer-provided health care. The ACA’s EHB provisions essentially mean that the insurer has to cover any illness, medical condition, or chronic disease that you might have. By repealing EHBs, insurers could create insurances plan that don’t include coverage for things like kidney disease and cancer.  It would allow insurers to get around covering pre-existing conditions.

Market stability

  • AKF supports ensuring that the market is stable so consumers have access to insurance plans that cover their health care needs. Health insurance for ESRD patients is a matter of life and death. Any changes including changes in tax credits, cost sharing or incentives to buy insurance that go into effect without giving insurers time to craft plans would jeopardize the insurance market and the access that consumers have to health insurance. 
  • AHCA would have ended the individual mandate as of January 1, 2016, so individuals would not be required to buy health insurance.
  • AHCA would have eliminated cost-sharing subsidies, which is when the government pays for copays or coinsurance, as of January 1, 2020. 
  • AHCA would have included a late-enrollment penalty. Individuals who buy non-group coverage and who have not maintained “continuous coverage” would have to pay 30% of otherwise applicable premium. “Continuous coverage” is defined as not having coverage of more than 63 consecutive days or longer in a 12-month period lookback. It would apply to special enrollment periods (SEPs) for the 2018 plan year and all other enrollments in 2019.

Election of tax credit Instead of government or group plans

  • AKF supports allowing ESRD patients, who are eligible for Medicare 90 days after starting dialysis treatment, to choose to an insurance plan that best suits their individual needs and is best for them and their families; hence, AKF supports allowing individuals to stay on private insurance in the individual market and use tax credits to pay for the coverage. 
  • AHCA did not offer tax credits to patients for the individual market if they were “eligible” for other types of insurance including employer plan, Medicare, Medicaid or CHIP, or Tricare.
    The American Kidney Fund does not have a position on the AHCA. However, the AHCA included a number of provisions that are not consistent with our principles on health care. We strongly support ensuring that any new legislation includes protections for ESRD patients.

We will continue to monitor health insurance legislation, and we will keep you posted.

Posted: | Author: Deborah Darcy