GOP Plan to Replace Affordable Care Act Raises Anxiety, Doubts

By Jill Drachenberg, Editor, AHC Media

After weeks of speculation and in-party bickering, the House GOP on Monday revealed its plan to repeal and replace the Affordable Care Act (ACA).

The American Health Care Act would take effect in 2020 and kills many aspects of the ACA that have long been points of contention with congressional Republicans:

• It eliminates the individual mandate and annual fine imposed on consumers who do not have health coverage, but it allows insurers to impose a 30% surcharge on top of base premiums for consumers who have had a lapse in coverage.
• The Medicaid program would change drastically. Beginning in 2020, federal funding to the states would be capped depending on the number of enrollees and their medical needs. States that receive greater Medicaid funding under the ACA Medicaid expansion will continue to receive those funds only for those enrolled prior to 2020.
• Subsidies that assist many low- and middle-income consumers to purchase insurance on the exchanges will be replaced with refundable tax credits that are dependent on age and income. Those under age 30 would be eligible for $2,000 per year, up to $4,000 for those over 60. The credit amounts decrease for individuals making more than $75,000 per year and more than $150,000 for married couples filing jointly. The law also encourages greater use of health savings accounts.
• The bill imposes a one-year freeze on federal funding for Planned Parenthood clinics. Consumers are barred from using tax credits to purchase insurance plans that offer abortion coverage.

It will, however, keep two largely popular aspects of the ACA: Young adults can stay on parents’ insurance through age 26, and patients with pre-existing conditions cannot be turned down for coverage.

The bill faces fierce opposition from congressional Democrats, as well as some Republicans concerned that the plan would leave millions of constituents uninsured. Four Republican senators wrote in a letter to Senate Majority Leader Mitch McConnell, R-KY, “We will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states … We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services.” Senate Republicans do not have enough seats to overcome a Democratic filibuster of the bill.

As of press time, there were no estimates of how much the bill will cost, or how many people will be covered. The House Ways and Means Committee is expected to start marking up the bill on Wednesday.

For more coverage on what’s ahead for changes to the ACA, see stories in the April issues of ED Management and Same-Day Surgery, as well as the February issue of Contraceptive Technology Update.