A topic of much discussion, but few solutions, has been healthcare in America. President Donald Trump was supposedly elected, in part, because of his promises to “Repeal and Replace” the Affordable Care Act, aka “Obamacare.” Many politicians and reporters were talking about passing the replacement bill prior to the summer Congressional recess. We are currently in that recess, and clearly, no such bill has been passed.
In today’s hyper-partisan world, it is tough to get all senators or representatives from one side of the political aisle to vote for something together; the idea that senators or representatives from the other party may vote in tandem on such a hot-button issue is almost impossible.
Right now, the House of Representatives has passed a bill, the American Health Care Act (AHCA), while the Senate has introduced a discussion draft. It is highly unlikely that Senators will vote on a health care bill during the week they return from recess. Currently, Senate Majority Leader Mitch McConnell is sending several proposals and basic outlines to the Congressional Budget Office for scoring.
In the meantime, below is a side by side comparison of the House-passed AHCA with the Senate discussion draft bill. It is important to remember that this is not a comparison of two bills that have been passed and now must be reconciled – instead, it is more of a guideline to show where one side of the Legislature stands on the issues as compared to the other side of the Legislature.
Repeal of Medicaid Expansion
House-Passed AHCA
Provides the enhanced matching rate only for expansion-eligible individuals already enrolled in Medicaid as of Dec. 31, 2019 and do not have a break in eligibility for more than one month after that date. Those newly eligible or reenrolling could only do so at a state’s regular match rate.
Senate-Introduced Draft
Phases-down enhanced FMAP over three years beginning in 2021 for newly eligible beneficiaries (85% in CY 2021, 80% in CY 2022, and 75% in CY 2023), using regular match if higher. States implementing expansion after Feb. 28, 2017, not eligible for newly eligible match rate.
Incentives for Increased Eligibility Redeterminations
House-Passed AHCA
Requires States with Medicaid expansion populations to re-determine expansion enrollees’ eligibility every six months. Provides a temporary five percent FMAP increase to States for activities directly related to complying with this section. Effective Oct. 1, 2017.
Senate-Introduced Draft
Same as the AHCA, but it permits – not requires – it and allows for more frequent re-determinations.
Work Requirements
House-Passed AHCA
Allows states to apply optional work requirements for non-disabled, nonelderly, non-pregnant Medicaid beneficiaries beginning in FY 2018. Includes increased match for implementation activities.
Senate-Introduced Draft
Same as the ACHA, with parallel exceptions.
Patient and State Stability Fund
House-Passed AHCA
Provides for a fund to reduce costs for patients and to stabilize State markets. The fund:
- Provides $15 billion in 2018 and 2019 and $10 billion annually for 2020 through 2026.
- Adds via amendments $8 billion to assist those affected by health status underwriting in waiver states and $15 billion for maternity, newborn, mental health, and substance abuse care.
- Adds $15 billion for a federal “invisible high-risk pool” to offset high-cost patients’ expenses through reinsurance.
Senate-Introduced Draft
Establishes two funds, short term and long term:
- Short term: appropriates $15 billion for CY 2018 and 2019 and $10 billion for years 2020 and 2021 to help issuers deal with market disruption.
- Long term: provides $62 billion over 10 years for high risk program; premium stabilization; provider payments; cost sharing assistance. States must pay match starting CY 2022.
Continuous Health Insurance Incentive
House-Passed AHCA
For Benefit Year 2019, implements a 12-month lookback period to assess whether an applicant went without coverage for greater than 63 days and assesses a 30 percent premium surcharge for one year.
Senate-Introduced Draft
The current draft does not include any incentives for patients having continuous health insurance throughout the year.
State Waivers
House-Passed AHCA
Allows states to seek waivers of certain federal requirements. States may:
- Waive federal age-rating requirements and allow wider age bands;
- Waive federal essential health benefit requirements (EHBs) and define their own;
- Waive the ban on health status rating. Instead of imposing the AHCA’s one-year 30 percent premium surcharge for not maintaining continuous coverage, insurers would be permitted to charge higher premiums to those with preexisting conditions for a one-year period if they do not maintain continuous coverage. States must set up a high risk pool to elect this option.
Requires states to attest that their purpose is reducing premiums. Automatically approves waivers in 60 days for up to 10 years unless HHS intervenes to deny.
Senate-Introduced Draft
Provides $2 billion in grant funding through 2019, to incentivize states to apply for section 1332 waivers established by the ACA, under which a variety of requirements may be waived, including EHBs and regulations prohibiting subsidies off-Exchange. Does not permit waivers of community rating. It also removes requirements that 1332 waivers be budget neutral or achieve the same coverage rates as would otherwise be attained under Federal law. Further, it permits the use of State Innovation and Stability fund allotments to carry out waiver implementation.
Medical Device Excise Tax
House-Passed AHCA
Repeals the 2.3 percent excise tax on medical devices beginning in 2017 (when it is already suspended).
Senate-Introduced Draft
Repeals the tax beginning in 2018 (when it would otherwise have taken effect again).
Tax on Prescription Medication
House-Passed AHCA
Repeals the ACA pharmaceutical tax in 2017.
Senate-Introduced Draft
Repeals the tax one year later, in 2018.
Opioid Funding
House-Passed AHCA
Provides $45 billion in opioid funding over ten years.
Senate-Introduced Draft
Provides $2 billion in state grant funding for opioid efforts, in FY 2018.