House Continues to Develop ACA Repeal and Replacement Policies

On Friday, February 24th, the news outlet Politico released a copy of legislation being drafted by Republican Leadership in the House of Representatives that is intended repeal and replace the Affordable Care Act.  The legislation would effectively terminate the bulk of the Affordable Care Act at the end of 2019.  A wide range of policies are proposed to be terminated on December 31, 2020 with significant changes to the Medicaid and insurance marketplace taking effect simultaneously.  The bill includes proposals such as:

•                      Repealing the ACA advanced premium tax credits (APTCs) which are used to subsidize the purchase of health insurance on the exchanges;
•                      Repealing ACA taxes, including the increased Medicare tax; the tax on high-cost health plans; the health insurer tax; and the medical device tax, among others;
•                      Establishing a new tax credit to purchase insurance that is based upon age rather than income:
  •                 The credit would vary from $2,000 for individuals younger than 30 to $4,000 for individuals over 60. 
•                      Eliminating the increased Federal matching rate  (FMAP) for 1915k/Community First Choice services;
•                      Rescinding increased FMAP for the ACA expansion group;
•                      Setting a per-capita cap on Medicaid expenditures; and
•                      Providing $100 billion in grants to states in order to establish programs that support the insurance marketplace and individuals with significant health conditions.

Final policies that will be included in the ACA repeal/replace package are still very much under discussion.  In the Senate, several Republicans have previously expressed reservations and concerns about some of the policies that were included in this draft bill such as the repeal of Medicaid expansion, the implementation of per capita caps, and a policy to end funding for Planned Parenthood.  In the House, a number of conservatives expressed concern about the establishment of a new entitlement via the refundable tax credit.  Separately, President Trump endorsed many of the policies included in this draft legislation during his speech to Congress on Tuesday.  Specifically, he recommended expanding the use of Health Savings accounts and providing refundable tax credits to assist with the purchase of insurance.  More recently, Republican leadership has continued updating the legislation  Several news outlets have reported that a new copy of the bill is being shared with members of the Energy and Commerce committee, which is responsible for many of the repeal and replace policies.  Reporting indicates that the legislation is being protected in a reading room, where some members may view the bill but not remove any copies of the policy.  The legislation is expected to be considered in the Energy and Commerce committee this month, potentially as early as next week.   To read ADvancing States’s summary of the earlier legislation, click here.