AHCA Amendment May Help Replace ACA

April 27, 2017

With Congress’ return from their two-week recess, President Donald Trump is pushing them toward another dramatic showdown over the Affordable Care Act (ACA), despite outstanding obstacles to a beleaguered revision plan and the deadline to avoid a government shutdown. This heightened urgency is the desire by many to move on to other legislative objectives, notably tax reform. Passing an ACA revision would also allow the president to show progress on a major campaign promise as he completes his first 100 days in office.

The House Republicans have crafted an amendment—being offered by Rep. Tom MacArthur (R-N.J.)—to the American Health Care Act (AHCA), which is the product of ongoing negotiations between House leadership, moderate Republicans and the conservative members of the Freedom Caucus. The aim of the amendment is to attract enough conservatives and moderates that the measure can pass the House.

The newest iteration of the bill, as indicated in the MacArthur Amendment, will reinstate essential health benefits as the federal standard and keep the key provisions of the original AHCA bill, which was scuttled last month after the measure lacked enough votes to pass it.

The MacArthur amendment would allow states to obtain permission from the federal government to write their own list of essential health benefits and allow insurers to charge people with preexisting conditions higher premiums, as long as they also make a high-risk pool available to those patients — a change conservatives have wanted. As a concession to moderates, the amendment would also add back federal requirements for essential health benefits, which the measure’s current version instead leaves up to states.

Among the provisions maintained are guaranteed coverage, community-rating rules, coverage for preexisting conditions, and allowing dependents to remain on their parents’ health-care plan until the age of 26. But, in an attempt to reconcile the desire for greater coverage with conservative concerns about the ACA’s regulations and ensuing premium hikes, the amendment will also offer states the option of obtaining limited waivers for some of the AHCA’s requirements.

States could seek these waivers for essential health benefits and community-rating rules, except for those regarding gender, age, and health status (with the exception of states with high-risk pools). States can only access these waivers if they intend to do so for the purpose of reducing premium costs, increasing the number of people insured, or otherwise benefiting the state’s public interest.

House leadership and committees are taking a secondary role in the negotiations, which are being largely carried out by Rep. MacArthur, head of the moderate Tuesday Group, and Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus. Reps. Meadows and MacArthur are currently gauging their members’ support for the proposed changes.

Although it is possible that Congress might revisit the AHCA and this amendment this week, the looming possibility of a government shutdown on April 28 forces them to first deal with a spending bill. Congress has a brief window to pass a spending bill, a tight timeline under the most generous of circumstance that would be nearly impossible to meet if House leaders also try to schedule a vote on the repeal legislation. Several Republican and Democratic aides have said there is a chance that both parties could agree to pass a very short-lived spending bill — one that kept the government open one week, for instance — to give negotiators time to carefully complete a broader spending agreement. But Democrats are already warning that they could walk away if Republican leaders push for repeal.

Democrats have so far been willing to work with Republicans to avoid a government shutdown, but any effort to schedule a vote to repeal the ACA could destroy those talks and threaten a government shutdown that Republicans have vowed to avoid.