Seven years after the Affordable Care Act was signed into law, the U.S. House of Representatives has passed the American Health Care Act (AHCA), a plan to repeal or change spending-related provisions of the ACA.
While the legislation leaves many parts of the ACA untouched, it implements significant changes to Medicaid expansion, federal funding for Medicaid, and premium tax credits. It eliminates cost-sharing subsidies, and the penalties associated with the individual and employer mandates, and it delegates essential health benefits rule-making to states.
How did the House pass the AHCA?
- The Congressional Budget Office projected that the AHCA would increase the number of uninsured by 24 million (the addition of the Manager’s Amendment to the bill did not change the CBO’s projection). That’s a big obstacle to overcome, but Congressional Republicans have been pushing to repeal the ACA for seven years, and many current lawmakers campaigned on a promise to repeal the law as soon as possible. Although the AHCA didn’t initially garner full support among Republicans, the prospect of being able to claim success in repealing the ACA — or at least portions of it — was apparently enough to overcome lawmakers’ qualms about the bill.
- The Congressional Budget Office projected that the AHCA would reduce federal deficits by $150 billion over the next decade. Although this is smaller than the $337 billion reduction in the federal deficits that had been projected prior to the addition of the Manager’s Amendment to the AHCA on March 20, it’s still a savings, which appeals to fiscal hawks.
- In last-minute meetings with the House Freedom Caucus, the Trump Administration offered to repeal the ACA’s essential health benefits requirements for individual market plans. After the meetings, Freedom Caucus members initially said that no deal had been reached, but enough of them voted for the legislation to pass it on to the Senate.
What happens next?
- The legislation now heads to the Senate, where its future is uncertain at best. The last-minute concessions the Trump Administration offered to win votes in the House will make the bill less likely to pass in the Senate. And there were already numerous Senate Republicans who had expressed concerns about the AHCA. As in the House, they’re on both ends of the Republican spectrum: Senator Rand Paul opposes the AHCA because he views it as “Obamacare Lite” while Senator Susan Collins opposes it because it would put coverage out of reach for low-income older Americans.
- The Senate has begun work on its own health care reform bill, said to be very different from the AHCA.
Who will lose coverage if the AHCA is enacted?
- On March 13 (prior to the Manager’s Amendment that was added to the AHCA and the last-minute changes that were being considered by lawmakers and the Trump Administration), the Congressional Budget Office released its analysis of the AHCA. The CBO projected that the AHCA would increase the uninsured population by 24 million people over the next decade. On March 23, the CBO announced that the Manager’s Amendment would not change the number of people who would become uninsured under the AHCA.
- Here’s a breakdown of who
. Some people will choose to drop their coverage (which will have destabilizing impacton the insurance markets). Others will lose access to Medicaid or employer-sponsored insurance. And others will be forced to drop their coverage due to affordability issues.