U.S. House Postpones ACA Repeal, Replacement Bill

On March 23—seven years to the date of the Affordable Care Act's (ACA) passage—the U.S. House of Representatives was set to consider legislation that would impact the future of our country's healthcare system. The American Health Care Act (AHCA), which seeks to repeal provisions of the ACA and includes replacement measures long-sought after by Republicans, underwent last-minute revisions in the week leading up to the vote in an effort to secure support from uncommitted Republican members. Some of the changes included setting aside additional tax credit support that could be dedicated to off-setting some of the higher premium costs for older Americans, as well as modifying Medicaid, such as by including options for states to impose work requirements on certain Medicaid beneficiaries and to receive funding structured under a block grant. 

As originally introduced, the AHCA makes changes to the ACA’s provisions addressing insurance affordability, 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 its overall savings.

Last week, Governor Rick Snyder joined Governors John Kasich (Ohio), Brian Sandoval (Nevada) and Asa Hutchinson (Arkansas) in sending a letter to U.S. House Speaker Paul Ryan and U.S. Senate Majority Leader Mitch McConnell, outlining a proposal that includes more flexibility for states to set up per capita systems, new forms of block grants or maintaining the current Medicaid federal/state structure with reduced federal financial commitments.

American Academy of Family Physicians (AAFP) issued its official position on March 20, opposing the AHCA based on deep concerns over the provisions that would ultimately put millions of individuals at risk for losing healthcare coverage and access to primary care.

MAFP has also consistently advocated that a specific set of principles be maintained in any reform effort—a position that was articulated in a letter sent to Governor Snyder on January 6:

  • Currently insured individuals should not lose public or private health insurance.
  • Under current law, individuals and families benefit from protections against discrimination in all health insurance marketplaces and in other insurance products. These patient-centered protections must be maintained and are essential to ensuring that all individuals, regardless of age, race, gender or medical history, can obtain quality, affordable health insurance.
  • Individuals and families should not lose Medicaid coverage. In addition, the functions of Medicaid should be universal, meaning regardless of one's state of residency, individuals enrolled in Medicaid must be guaranteed healthcare coverage that is equitable to coverage in any of the other states.
  • Primary care is and must remain a critical and foundational component of any healthcare system

Depending on the outcome in the U.S. House, the bill would still face a 51-vote hurdle in the U.S Senate. READ MORE