ACA Repeal, Replacement Bill Raises Significant Concerns for the Academy

On March 6, Congressional Republicans released the American Health Care Act (AHCA), a bill package aimed at repealing and replacing aspects of the Affordable Care Act (ACA).

Specifically, the AHCA makes changes to the ACA’s provisions addressing insurance affordability, the individual and employer mandates, taxes and Medicaid reforms. One of the most notable changes includes structural reforms to Medicaid that transition Medicaid funding to a per-capita cap by 2020. In addition, starting in 2020, states would no longer receive higher federal match payments for any new enrollees under Medicaid Expansion and, although states would still get the higher match rate for beneficiaries enrolled before 2019, they would have to stay enrolled without a break in coverage (lest they, too, would be subject to coverage at the lower federal match rate). While not directly repealing Medicaid Expansion per se, this cost-shift would very likely put an increased burden on state governments that wish to continue coverage for those who aren’t “grandfathered” in. Absent any actions taken by the state legislature, Healthy Michigan would effectively be terminated, as the authorizing state statute requires that the cost of the program not exceed the program's overall savings.

The American Academy of Family Physicians (AAFP), along with the American Medical Association and other physician groups, expressed significant concerns regarding the bills' shortcomings in protecting the millions of Americans who have received healthcare coverage under the ACA, and the potential widening of access issues that already plague our healthcare system. AAFP sent letters on March 7 to the House Ways and Means and Energy and Commerce Committees expressly citing these concerns in addition to concerns surrounding the committees’ efforts to advance legislation without a Congressional Budget Office score.

The House Energy and Commerce and Ways and Means Committees began their respective markups of the AHCA on March 8. After a lengthy debate, which saw several defeated amendments offered by Democrats, the Ways and Means Committee passed legislation along party lines in the early morning of March 9. The bills still have a long road ahead, including meeting a 51-vote threshold in the Senate, and we are likely to see the package evolve as it advances through both the upper and lower chambers.