AHCA legislative update

The Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) March 13 released an estimate of the effects on health coverage of the American Health Care Act (AHCA), the legislative package passed last week by the House Ways and Means and Energy & Commerce committees to repeal and replace parts of the Affordable Care Act (ACA).

CBO and JCT estimate that in 2018 14 million more people would be uninsured under the legislation than under current law. Overall, the report estimates that nearly 24 million people would lose coverage over 10 years. CBO and JCT estimate that the legislation would reduce federal deficits by $337 billion over the 2017-2026 period. The largest savings would come from reductions in outlays for Medicaid and from the elimination of the ACA’s subsidies for non-group health insurance.

“The CBO number reinforces our concerns about the importance of maintaining coverage for those vulnerable patients who need it,” said AHA President and CEO Rick Pollack. “As we said in our letter to Congress last week, any changes to the ACA must be guided by ensuring that we continue to provide health care coverage for the millions of people who have benefited from the law. We cannot support a bill that the CBO and others clearly indicate would reduce coverage for so many people.”

The House Ways and Means and Energy & Commerce committees last week reported out the AHCA that is designed to repeal and replace parts of the ACA.

The Ways and Means bill would repeal the ACA’s employer and individual mandates to purchase health coverage and replace the law's means-tested advance premium tax credits and cost-sharing reductions with tax credits that vary by age and income.

The Energy & Commerce bill would end the enhanced Medicaid federal funding for future expansion populations, beginning in 2020, and transition the program to a per capita cap funding model. The package does not restore the hospital market basket reductions or Medicare disproportionate share hospital cuts used to help fund the ACA coverage expansions. AHA members received a Special Bulletin March 7 with further details.

The AHA wrote House members that it cannot support the package in its current form. House leaders have expressed a desire to have the package on the House floor before the end of the month. It now goes to the House Budget Committee, where the bills will be combined into one piece of legislation.

Hospital and physician groups weigh in. In a March 8 letter to members of Congress, the AHA, America’s Essential Hospitals, Association of American Medical Colleges, Catholic Health Association of the United States, Children’s Hospital Association, Federation of American Hospitals, and National Association of Psychiatric Health Systems said they “cannot support the American Health Care Act as currently written.” Absent Congressional Budget Office analysis, “our assessment of this legislation as currently drafted is that it is likely to result in a substantial reduction in the number of Americans able to buy affordable health insurance or maintain coverage under the Medicaid program,” the hospital organizations said.

The groups added that “maintaining deep provider reductions while dramatically reducing coverage will reduce our ability to provide essential care to those newly uninsured and those without adequate insurance.”

In a separate letter, the American Medical Association told House committee leaders that it “cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.”