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Legislation to Partially Repeal and Replace the ACA Clears Final U.S. House Committee; Floor Vote Possible Next Week

March 16, 2017

The American Health Care Act (AHCA), legislation that would partially repeal and replace the Affordable Care Act (ACA), cleared the U.S. House Budget Committee by a narrow vote of 19 to 17. The legislation could be considered on the U.S. House Floor as early as next week.

Congress has been advancing the partial repeal of the ACA using the budget reconciliation process, which allows expedited legislative procedures and requires a simple majority vote (51) in the U.S. Senate rather than 60 votes.

As required by the reconciliation process, the Budget Committee combined the legislative recommendations submitted by the U.S. House Ways & Means and Energy & Commerce Committees, after contentious consideration of the policy package in the committees last week.

The AHCA would repeal and replace significant aspects of the ACA, which has extended health care coverage to more than 1.1 million Pennsylvanians. Specifically, the legislation would:

  • Freeze and phase out expanded coverage under the Medicaid program
  • Implement alterations to the financing structure of the Medicaid program by capping federal support
  • Replace current subsidies that help Pennsylvanians purchase coverage through the health insurance marketplace with advanceable tax credits
  • Eliminate the individual and employer mandates, but incentivize coverage by applying a penalty on individuals that do not maintain “continuous coverage”
  • Seek to support coverage by establishing a fund that states could use to establish high-risk pools, reinsurance programs, provide cost-sharing support, or promote access to preventive services

The Congressional Budget Office released an analysis of the legislation on Monday projecting 24 million more Americans would be uninsured by 2026. HAP’s review of the analysis supports the conclusion that the AHCA “does not fulfill our core principle that any replacement plan must ensure continuity of coverage and care through access to a robust, competitive delivery system.”

More than half of Pennsylvania’s 1.1 million individuals who secured coverage under the ACA likely would lose their coverage by 2018 and, by 2026, the number of uninsured in Pennsylvania likely would increase to pre-ACA levels.

Although House leaders are committed to bringing the bill to the House floor next week, they face challenging dynamics in balancing the perspectives within the Republican conference.

Three conservative lawmakers on the Budget Committee voted against the legislation on the grounds that it does not go far enough in repealing the ACA. Center-right Republicans have expressed concerns regarding rolling back Medicaid expansion and the sufficiency of the tax credits.

Many U.S. Senators have indicated their own concerns with the legislation as well.

HAP remains steadfast in its position that the progress that has been made to benefit 1.1 million Pennsylvanians through expanded coverage should not be threatened, and has indicated to federal lawmakers that Pennsylvania hospitals cannot support the legislation as currently written.

For more information on the AHCA and HAP’s advocacy activities, please contact Laura Stevens Kent, vice president, federal advocacy.

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