How the AHCA directly impacts significant parts of the ACA

Six weeks after pulling the American Health Care Act (AHCA) (H.R. 1628) from consideration, the House of Representatives passed an amended version of the bill on May 4, 2017, by a vote of 217 to 213. The legislation makes significant changes to some parts of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), in particular repealing the employer and individual mandates; scaling back Medicaid expansion; and repealing many of the taxes included in the ACA. The House also passed H.R. 2192, which would eliminate provisions that exempt members of Congress and congressional staff from state waiver provisions, in response to criticisms that the AHCA would affect all Americans except those voting on the bill (see The AHCA strikes back, Health Law Daily, May 4, 2017).

The Senate is now considering the legislation, and is likely to make substantial changes to the AHCA, or even start from scratch on new legislation. Moderate Republican senators in particular are concerned about the changes to Medicaid coverage that roll back the ACA’s expansion of the program.

This White Paper will compare provisions of the AHCA with the ACA. One thing to note at the outset is that the ACA as enacted in March 2010 included 10 titles, while the AHCA makes significant changes to only three of the titles. Much of the ACA, especially related to the Medicare program and the training of various types of medical practitioners, therefore, would remain intact if the AHCA passes in its current form.

In addition, the Trump Administration has stated more than once that it sees the rollback of the ACA as occurring in three stages—(1) legislation to repeal or change ACA provisions that would allow the Senate to pass a bill with a bare majority under the budget reconciliation process; (2) administrative actions to provide patients with additional insurance options and give states more flexibility in Medicaid spending, and (3) legislation on Trump’s other priorities including sale of health insurance across state lines and medical tort reform (see Is the American Health Care Act a ‘critical first step’ or unsupportable?, Health Law Daily, March 8, 2017).

Read further, “How the AHCA directly impacts significant parts of the ACA.”

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