House Republicans have unveiled their plan to repeal most of the ACA and replace it with new legislation: The American Health Care Act (AHCA).
Two separate House committees, the Energy and Commerce Committee and Ways and Means Committee, attempted to reshape our healthcare system by presenting the following:
- Eliminate the tax penalties, “individual mandate” and “employer mandate” imposed on those who don’t purchase health insurance for themselves or employees.
- Tax credits will be based on age rather than income ranging from $2000/year for those younger than 30 to $4,000 a year to those who are older than 60. A family would receive up to $14,000 in tax credits a year. These tax credits would start phasing out when income becomes $75K individually or $150K as a family. For every $1,000 in earnings above those thresholds, the value of the credit phases down by $100.
- Allow insurance companies to charge a 30% surcharge to those who have gaps in insurance longer than 63 days.
- Maintain coverage, preventing denial, to those with pre-existing conditions
- Maintain coverage for children under age 26 who wish to stay on their parent’s plans.
- Maintaing the bans on caps on annual or lifetime coverage
- By 2020, ACA promised federal funds for Medicaid expansion will stop. Funds will continue for current Medicaid recipients
- Create a Patient and State Stability Fund, which provides states $100 billion to use as they wish for their underserved populations, hospitals, providers or programs that would provide direct care.
- States will receive money for Medicaid in a lump sum per person rather than an open-ended promise of funds.
- Taxes on medical device industry will expire as will those on pharmaceutical companies and indoor tanning services.
- Planned Parenthood is “defunded” as AHCA funds cannot be used to pay for services at their clinics.
- HRA increase – starting in 2018 individuals could contribute pretax dollars to their Health Savings Account up to $6550 individually and families up to $13,100.
Now the committees need to “mark up” the bill where they review, debate and amend the legislation before presenting it to the Budget Committee and then the floor of the House of Representatives.
Critics on both sides have aired their concerns. According to Fox News, Senate Minority Leader Charles Schumer, D-N.Y., said the proposal “would cut and cap Medicaid, defund Planned Parenthood, and force Americans, particularly older Americans, to pay more out of pocket for their medical care all so insurance companies can pad their bottom line.”
Senator Rand Paul told Fox News he would not vote for “Obamacare Lite”. He stated, “Some Republicans want to keep parts of Obamacare, and I’m not going to vote for that.”
The problem I see is the premium hikes and high deductibles would still take years to revert back to their pre-Obamacare days, assuming the damage hasn’t been permanent. The GOP is trying to delicately pull the tablecloth out from under a fragile healthcare system and will still cause some glasses to fall and break. Should they reset another table that eveyone can move to? Should they just rip the tablecloth off and rebuild? Should they clear the plates and reset it with their own china?
I’ve urged the GOP to get rid of the mandates and incentive purchasing coverage so I’m a fan of those inclusions in this bill. The Patient and State Stability Fund gives states more power to choose how to help their citizens, so I find this another promising piece. Whether its the best suggestion for a “repeal and replace” has yet to be determined because the GOP is swimming upstream on this one. Let’s hope the current calms down enough to allow some reform to take place.
A copy of the legislation is provided here: https://www.dropbox.com/s/4f82iy7d92u0c3a/AmericanHealthCareAct.pdf?dl=0
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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician