House Republicans have filed legislation that would repeal most of the Affordable Care Act, including measures to eliminate the employer and individual mandates.
But from the get-go the legislation – backed by the House leadership – was panned by the GOP’s conservative wing, which said it doesn’t go far enough to completely get rid of the ACA, casting doubt on the prospects of it getting passed.
And Congressional Democrats immediately voiced their absolute opposition to the bill, vowing to vote ‘No’ on the legislation.
While passage in the House would be a bit easier, the slim 51-49 vote edge that Republicans hold in the Senate means it’s unclear whether the bill can pass in its present form.
But for now, this is the only piece of viable legislation that’s been floated to gut the ACA, and replace it with a scaled-down version.
The leadership is mindful that they cannot do an outright repeal, since it would affect some 20 million people who have been able to secure health insurance under the ACA.
The bill, called the American Health Care Act, would be phased in over time and would keep the ACA’s premium subsidies for policies purchased through insurance exchanges until 2020, as well as fund Medicaid expansion under the ACA for the same time.
This is just the first draft, and because of the opposition from conservatives in the Republican Party, the current version will not likely be the final one.
House Speaker Paul Ryan has said he wants to see the bill passed by Congress by the end of April. In other words, there will be a lot of work to do in very short order.
Here are some of the major provisions of the bill:
- Eliminating the employer mandate that requires employers with 50 or more full-time or full-time equivalent workers to offer health insurance.
- Eliminating the individual mandate requiring Americans to be covered either through their employment or by purchasing coverage on the open market or a health insurance exchange.
- Ending the funding for Medicaid expansion as of 2020.
- Converting the Medicaid to a program of capped per-capita federal grants to the states, starting in 2019.
- Eliminating the subsidies available under the ACA and replacing them with age-based, refundable premium tax credits to help people buy insurance. Under the ACA subsidies are based on income, not age, and the proposed age-based tax credits generally would be smaller than the ACA’s.
The tax credits proposed by House Republicans would start at $2,000 a year for a person under 30, rising to a maximum of $4,000 for a person 60 or older. A family could receive up to $14,000 in credits. - Removing ACA taxes and penalties (adding a premium incentive for continuous coverage and allowing insurers to tack on a 30% surcharge for people who let their policies lapse).
- Protecting employer exclusion (tax write-off for employers and pre-tax for employees).
- Retaining the “Cadillac tax” on high-value plans, but delaying its implementation to 2025 from 2020.
- Eliminating the requirement that plans must offer minimum essential benefits.
- Offering states $100 billion over nine years to establish high-risk pools or other mechanisms for stabilizing the individual insurance market.
- Allowing insurers to charge older individuals five times higher premiums than they charge younger people. That’s compared with the 3 to 1 ratio under the ACA.
- Expanding and promoting health savings accounts.
The fate of the legislation remains to be seen and under the proposal, it would surely not live up to President Trump’s promise that individual plans would be better and less expensive under the GOP’s ACA replacement.
We will keep you posted as the legislation develops.