For those of you waiting on the edge of your seat, the American Health Care Act (AHCA) passed its way through the House today. Does this mean Obamacare is dead? No. At least not yet. Let’s recap.
What is the AHCA?
It’s also known as “repeal and replace” bill, intended to replace the Affordable Care Act. While it did not propose to get rid of the employer and individual mandate to provide health insurance, it would reduce the penalties to $0 effective 1/1/2016. The bill further delays the very unpopular Cadillac tax until 2025. And also makes changes to FSA and HSA accounts allowing individuals to use those funds to pay for over the counter medications, among other things. The premium tax credits (or subsidies) that individuals receive now to obtain insurance on the exchange (or Marketplace) would be expanded so anyone purchasing individual policies would potentially qualify.
Just as importantly, the AHCA is not proposing to eliminate pre-existing exclusions; end adult child coverage; or change the 100% coverage of preventative care. Nor is it proposing to end the prohibition on annual and lifetime limits, a waiting period of greater than 30 days, or rescission of coverage. And it does not touch IRS reporting requirements (1094 & 1095 forms).
How did we get here?
The original AHCA was drafted by the Budget Committee as a result of an Executive Order signed on President Trump’s first day in office. It was very intentionally done as such, so that when the bill gets to the Senate, the Senate could take advantage of the budget reconciliation rules, which allow for a bill to pass with a mere 51 votes, as opposed to the typical 60 votes. With 52 Republicans in the Senate, it also likely prevents the ability for a filibuster.
The bill was made public on March 6, 2017, and subsequently passed the Ways and Means and Energy and Commerce committees, despite the Congressional Budget Office review not being complete before the committees’ votes (causing much backlash, especially once the review released that an additional 24 million would lose coverage under the proposal). On March 24, 2017, the bill went to a vote before the entire House and was postponed when it became clear there would not be enough votes on the Republican side to move forward.
Over the last week, there have been rumors the AHCA was coming back up for a vote. In order to obtain some crucial support with Republicans, an amendment was offered that would allow states to choose to opt out of certain parts of the law. Insurance carriers would be able to take pre-existing conditions into consideration when charging for health insurance, though a provision was added providing for $8 billion to states to dole out to those with pre-existing conditions to help cover the cost of insurance.
The bill passed the House today very much along party lines, with 217 out of 238 Republicans voting yes.
Despite the fact the bill passed the House today, it’s still just a bill. (For a good reminder of how the legislative process works, check out this excellent School House Rock!)
The next hurdle is passing the Senate. If the bill continues to only garner support along party lines, Republicans need to get nearly every single vote from the 52 members presently in the Senate. This won’t happen overnight though - the Senate cannot schedule this for a vote until a new review is performed by the Congressional Budget Office, since the CBO hasn’t provided input on the AHCA with the recent amendments. Even when this becomes available (likely early June), the second-ranking Republican in the Senate, Senator John Cornyn (R –TX) said “there is no timeline… when we get 51 senators we’ll vote.”
If implemented, what would these changes mean to you? To your organization? Tell your legislators. According to SHRM, 94% of staffers say the most influential voice to legislators is that of their constituents. They want to hear from you! SHRM’s A-team makes it easy to locate and contact your representatives and even provides talking points or sample letters. Join at www.advocacy.shrm.org/about. And to learn more about SHRM’s position about healthcare reform matters, check out the 2017 public policy guide.