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The America Health Care Act

Our Executive Committee recently had the privilege of hearing from our Congressman, Gary Palmer, about his amendment to start the ObamaCare repeal and replace process.  There is a lot of misinformation being passed around about this crucial measure, and Rep. Palmer's office has helpfully provided the information below about what is (and is not) in the American Health Care Act.  We hope you'll read it and share it with your friends.

American Health Care Act

The AHCA as amended delivers relief from Obamacare’s taxes and mandates that have hurt job creators, increased premiums, and limited options for patients and health care providers. It returns control of health care from Washington back to the states and restores the free market so Americans can access quality, affordable health care options that are tailored to their needs. 


The AHCA will deliver the control and choice individuals and families need to access health care that’s right for them. And provide the freedom and flexibility states, job creators, and health care providers need to deliver quality, affordable health care options. 


Pre-existing Conditions: The Upton-Long Amendment provides an additional $8 billion in resources over 5 years for patients with pre-existing conditions. The funds are dedicated solely to reduce premiums and other out-of-pocket costs for patients in the individual market with pre-existing conditions who do not maintain continuous coverage and who live in states that receive a waiver to redesign their insurance market. 

This $8 billion is on top of the $130 billion available to states through the AHCA’s Patient and State Stability Fund, which helps states repair their health markets damaged by Obamacare. 


States can use the funds to:

  • cut out-of-pocket costs, like premiums and deductibles 

  • promote access to preventive services, like getting an annual checkup, as well as dental and vision care

  • promote participation in private health insurance or to increase the number of options available through the market


Further, the AHCA provides a refundable tax credit to those without other health care options so they can get – and stay covered – before they face a serious medical event or suddenly fall ill.


The MacArthur Amendment keeps our promises of lowering costs and protecting high-risk patients by giving states greater flexibility and more control over local insurance markets by providing states the option to apply for waivers from certain federal insurance regulations that increase insurance premiums. This new flexibility will allow states to design insurance frameworks that are right for their unique populations, providing superior care and lowering costs for patients. Any states that apply for a waiver must attest that its purpose is to reduce the cost of health care or increase the number of people with health care coverage. 


The MacArthur Amendment explicitly maintains protections for pre-existing conditions. NO STATE, under ANY circumstances, may ever obtain a waiver for guaranteed issue of coverage, guaranteed renewability of coverage, or the prohibition on denying coverage due to pre-existing conditions.

The amendment specifically clarifies that its provisions cannot be construed as allowing insurers to limit coverage for those with pre-existing conditions. All of these protections will remain the law. 


This legislation addresses the 7% of Americans on the individual market, and those in the small group market. Anyone with employer-provided coverage or government coverage (Medicare, Medicaid, Tricare, VA benefits, etc.) would not be affected. Again, this amendment would not allow any state to deny coverage to those with pre-existing conditions, and would require the extensive protections described above for those with riskier health profiles. It is also worth noting that many states required insurers to offer coverage to those with pre-existing conditions before Obamacare was implemented. 


In order to obtain a waiver, the MacArthur amendment requires states to set up a program for high-risk individuals or premium stabilization, or to participate in the Federal Invisible Risk Sharing Program. 


Importantly, these higher premiums could only be charged for a period of one year to an individual who did not maintain continuous coverage. After an individual has maintained continuous coverage for twelve months they would then return to standard rates. This means that the protections against being charged higher premiums for a health condition are preserved for every individual market plan holder who maintains continuous coverage. 

High Risk Pools: Under AHCA, states would have access to a new Patient and State Stability Fund to help finance risk-sharing programs like high-risk pools, as well as a new Federal Invisible Risk-Sharing program. All told, $130 billion dollars would be made available to states to finance innovative programs to address their unique patient populations. This new stability fund ensures these programs have the necessary funding to protect patients while also giving states the ability to design insurance markets that will lower costs and increase choice. 


Additionally, there will be a separate fund of $8 billion dedicated solely to reduce premiums and other out-of-pocket costs patients in the individual market with pre-existing conditions who do not maintain continuous coverage and live in states that request and receive a waiver. 


Under our plan, the 10 Essential Health Benefit Categories would remain the federal standard. States could seek a waiver to establish new benefit standards, but subject to certain conditions: the state must publicly attest its purpose for doing so (to reduce the cost of healthcare coverage, increase the number of people with healthcare coverage, etc.) and it must specify the benefits it will require instead of the federal standard. 


The plan does not eliminate the standard that women and men are treated equally when it comes to cost. And we do not remove access to preventative and screening services, like mammograms, gestational diabetes, breastfeeding support and counseling, and well-woman visits, to name a few. 


Health Rating: The MacArthur amendment’s limited waiver for health rating requires states to set up a program for high-risk individuals or premium stabilization, or to participate in the federal invisible risk sharing program. No state may obtain a waiver for health status unless it has taken these efforts to protect those who might be affected. In states with a waiver, individuals who maintain continuous coverage could not be rated based on health status. 


Essential Health Benefits: This amendment ensures essential health benefits are the federal law of the land and maintains other important protections. States have the option to obtain a waiver regarding federal essential health benefits, but the state must publicly attest its purpose for doing so (to reduce the cost of health care coverage, increase the number of people with health care coverage, etc.) and it must specify the benefits it will require instead of the federal standard. NO STATE, under ANY circumstances, may ever obtain a waiver for pre-existing condition protection, prohibition on gender discrimination, for guaranteed issue and renewability, or for the right of dependents to stay on a family plan up to age 26.  


Affordable Care Act Fines and Mandates: The plan does not allow the IRS to fine Americans for choosing not to buy government-approved care. The IRS should not be policing your health care. 


In order to prevent gaming of the system and help keep premiums lower for everyone, our plan would allow carriers to charge a flat, one-time, 30% surcharge on top of a premium if an individual has not maintained continuous coverage. The continuous coverage provision is important to ensure individuals cannot unfairly game the system and pay for coverage only when they have medical bills. Individuals can go without coverage for sixty-three days and still maintain continuous coverage status. 


Medicaid: The Medicaid program today is a critical lifeline for some of our nation’s most vulnerable patients. But the program now has three times as many people and costs three times as much as it did under former President Clinton. By expanding Medicaid, Obamacare prioritized able-bodied adults above those the Medicaid program was originally designed to help. We will not pull the rug out from anyone as we work to give states the flexibility they need to take care of those most in need. 


Our plan responsibly unwinds Obamacare’s Medicaid expansion. We freeze enrollment and allow natural turnover in the Medicaid program as beneficiaries see their life circumstances change. This strategy is both fiscally responsible and fair, ensuring we don’t pull the rug out on anyone while also ending the Obamacare expansion that unfairly prioritizes able-bodied working adults over the most vulnerable. 


Medicaid Expansion: To responsibly unwind expansion, our plan would freeze new enrollment in Obamacare’s Medicaid expansion and grandfather existing enrollees. Under the expansion freeze, individuals currently enrolled in Obamacare’s Medicaid expansion would remain enrolled in the program if they otherwise remain eligible, and expansion states would continue to receive the enhanced match under current law ONLY for existing beneficiaries. Over time, as the individuals see changes to their income or eligibility, they will naturally cycle off the program. To protect against padding the rolls, the AHCA says that states can no longer enroll individuals onto to Medicaid at the enhanced match. States could continue to enroll Americans on Medicaid at their lower, traditional match rate.  


This freeze policy would prevent disruption for Medicaid beneficiaries, but also transition individuals to purchasing private coverage in an improved commercial market with the support of a refundable tax credit and through innovative programs established in their state and funded by the AHCA’s Patient and State Stability Fund, Our plan incentivizes and rewards patients for keeping health insurance. To be sure – even if a patient is dealing with a serious medical issue, they will never be charged more than standard rates as long as they maintain coverage. 


Mental Health Provisions: The AHCA as amended includes $15 billion specifically toward mental health and substance abuse disorders. The plan does not change mental health parity rules. 


Planned Parenthood: Our plan imposes a one-year freeze on federal funding for organizations that provide abortion services.


State Per Capita Allotments: Under this plan, the federal government would continue to provide matching funds for State Medicaid programs to cover each person enrolled in a State’s Medicaid program. However, this policy would set limits on the federal government’s spending on Medicaid, calculated by accounting for the number of enrollees overall and the capped per capita amount per eligibility category. The allowable per capita amount per eligibility category would be determined using each State’s actual historical experience of the average cost of an enrollee in each eligibility group.




For full details, visit: https://housegop.leadpages.co/healthcare/