The House May 4, 217 to 213, passed the American Health Care Act (AHCA, H.R. 1628), legislation that repeals significant portions of the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152) and changes the Medicaid financing structure [see Washington Highlights, March 10 and April 28]. The vote largely followed party lines, with all Democrats and 20 Republicans voting against the bill.
AAMC President and CEO Darrell G. Kirch, MD, May 4 expressed disappointment in the House passage of AHCA, but also stated, “We encourage the Senate to take a different approach that fixes current problems without creating new ones. Key to this approach is committing to high-quality, affordable, comprehensive coverage for all, including maintaining Medicaid expansion and protecting individuals with preexisting conditions, as well as other vulnerable patients who depend on the nation’s teaching hospitals and physicians for their care. The AAMC stands ready to engage with the Senate to find ways to improve health care for all Americans.”
The vote came after weeks of back-and-forth where House Republicans struggled to find support for the legislation. The most recent amendment, authored by Reps. Fred Upton (R-Mich.) and Billy Long (R-Mo.), aimed to alleviate the concerns of some moderate Republicans that the bill does not adequately protect those with preexisting conditions. The Upton amendment creates an $8 billion fund available from 2018 to 2023 to states that waive the 30 percent premium penalty for those who fail to maintain continuous coverage and institute premium rating based on health status.
Moderate Republicans expressed concern that individuals with preexisting conditions who fail to maintain continuous coverage in states that waive the 30 percent premium penalty would then face unaffordable costs. The funds made available in the Upton amendment are to be used to help defray costs by reducing premiums or other out-of-pocket expenses. Many argue that the additional funds in the Upton amendment are relatively small and will not adequately cover costs for those with preexisting conditions.
In a joint statement, House Energy and Commerce Committee Chair Greg Walden (R-Ore.) and Health Subcommittee Chair Michael Burgess, MD, (R-TX) celebrated the passage of the AHCA, saying, “For seven years, our constituents, patients, friends, and family have suffered under a one-size-fits-all law that is collapsing under its own weight. The American Health Care Act will put patients, families, and their doctors first. It will protect those with pre-existing conditions and provides states with the flexibility they need to help meet the unique needs of their citizens.”
Ways and Means Committee Ranking Member Richard Neal (D-Mass.) expressed his disappointment with the bill’s passage, saying, “Despite the absence of analysis from the Congressional Budget Office and without a single public hearing on this bill, Republicans followed through on seven years of threats to destroy the health care of millions of Americans by forcing them to pay more for worse coverage. Instead of working with Democrats to improve health care in this country, Republicans voted to remove key protections for Americans with pre-existing conditions, take away health insurance from 24 million, shorten the life of Medicare, and impose an age tax on seniors – all to pay for a giant tax cut for the wealthy.”
The AHCA will now progress to the Senate, where various Senate Republicans have indicated that the legislation will undergo a dramatic overhaul in the coming weeks. A specific timeline for the bill has not yet been set or made public.