The American Health Care Act Passes the House – What Happens Next?

Yesterday, the U.S. House of Representatives voted 217 to 213 to pass the American Health Care Act (AHCA). All Democratic Representatives and twenty Republicans opposed the bill; northern Virginia Representative Barbara Comstock was the only Virginia Republican to vote “no.”

What does the bill do? A few highlights: 

 * Repeals Taxes. Eliminates almost $900 billion in ACA-imposed taxes for higher-income taxpayers and health care providers/insurers.  

 * Guts Medicaid. The AHCA repeals Medicaid expansion and converts state Medicaid programs to a per capita cap or a block grant, at the same time reducing funding for Medicaid by $800 billion. This puts services and coverage at risk for the nearly 1 million Virginians currently enrolled in Medicaid – and leaves existing dental coverage vulnerable.

 * Repeals or Reduces Affordability Provisions.The AHCA repeals cost-sharing and vastly changes subsidies. Under the Affordable Care Act (ACA), low-income individuals receive subsidies to cover the cost of premiums. Subsidies are calculated through a complex formula that considers income, age, and geography. In Virginia, 82% of those purchasing insurance in the individual market received a subsidy. Under the AHCA, anyone making under $75,000 is eligible for a subsidy; the subsidy amount will be calculated by age alone with no adjustments for where a person lives or how much (or how little) money they make. In addition, under the AHCA, insurers can charge older Americans five times more than younger counterparts. Under current law, insurers can only charge three times more.

 * Guts Public Health Funding. The AHCA eliminates the Prevention and Public Health Trust Fund, which funds at least $20 million in Virginia programs. 

Enables States to End Protections for Individuals with Preexisting Conditions. ACA protections prohibit insurers from charging higher premiums to people with preexisting conditions; the AHCA allows states to opt out of these protections and charge higher premiums for people with preexisting conditions if they have more than a two-month lapse in coverage. States that do this must establish a high-risk pool. An additional $8 billion in funding is available over five years for states that choose to enable insurers to charge individuals with preexisting conditions more. Experts estimate this will woefully under fund high-risk pools.

 * Establishes a Patient and State Stability Fund. The AHCA establishes a Patient and State Stability Fund with $130 billion in federal funding over nine years. The fund may be used to: provide financial assistance for high-risk individuals; provide incentives to stabilize insurance premiums; promote preventive, dental and vision care, and mental health and substance abuse disorder services; pay providers directly for services; and/or, provide assistance to reduce out-of-pocket costs. States that receive this funding must begin providing a 50/50 funding match by 2026. 

 * Enables States to Establish Less Generous Essential Health Benefit Lists. The ACA outlined ten essential health benefits (EHBs) that insurers in all states are required to cover with no annual or lifetime limit, including: ambulatory patient services (outpatient care); emergency services; hospitalization (inpatient care); maternity and newborn care; mental health and substance abuse disorder services, including behavioral health treatment; prescription drugs; rehabilitation and habilitative services and devices; laboratory services; preventive services, wellness services and chronic disease management; and, pediatric services, including oral health and vision care. The AHCA allows states to identify their own lists of essential health benefits, even if they are less generous than the current federal requirements.

 * 24 million Americans will lose coverage by 2020. This number will likely rise once the Congressional Budget Office scores the bill with the inclusion of new amendments related to essential health benefits and preexisting conditions.

A comprehensive comparison of current law and the AHCA is available from our friends at Kaiser Family Foundation. 

What's next? 

The bill now heads to the Senate, with many Senators on both sides of the aisle expressing concerns about the provisions in the bill and indicating that they will rewrite the bill. Of note: 

  • The Senate will not vote on the bill without a score from the Congressional Budget Office (CBO). Most experts presume the AHCA in its current form will result in more uninsured individuals than the original CBO estimate from March, which will likely impact discussion and debate. 
  • Several Republican Senators led by Bill Cassidy (Louisiana) and Susan Collins (Maine) introduced health care legislation in January which could serve as a starting point. 
  • If the Senate votes on a different bill, the House will have to vote again.

What is the Virginia Oral Health Coalition doing? 

  • Making sure our state legislators, policy makers, and partners understand the implications of the AHCA for Virginia – specifically, how it could affect the state's Medicaid dental program and the overall health of Virginians;
  • Staying up-to-date on policy developments in the Senate; and, 
  • Reminding Virginia's Congressional Delegation of the impact the AHCA will have on Virginia. 

All of us at VaOHC remain committed to ensuring Virginians have access to affordable, comprehensive coverage that is inclusive of oral health! 

Other resources: 

Sarah Bedard Holland