On the afternoon of May 4, the House of Representatives narrowly approved the amended American Health Care Act (AHCA), eking out just enough votes to send the measure to the Senate. The final vote was 217 to 213, with all Democrats and 20 Republicans voting against (one Representative was not present for the vote, and four seats are currently vacant). The bill contained several provisions which would have a significant impact on disability services providers, particularly the conversion of the Medicaid program to a per capita cap structure. Though the bill voted on this week did not have an accompanying Congressional Budget Office (CBO) score prior to the vote, prior CBO estimates put the amount of federal Medicaid cuts as ranging from $839B to $880B. The most recent bill is estimated by outside groups to include cuts to federal Medicaid spending of at least $839 billion.
The bill passed containing the MacArthur amendment, which permits states to waive out of certain Affordable Care Act (ACA) requirements, including federal essential health benefits and community rating rules. These waivers would be available for states that have established a high risk pool or that participate in a federal high risk pool. (See WICs article, “AHCA Conversation Continues with New Amendment Offered,” April 24, 2017.) Additionally, the “Upton amendment,” introduced by Representative Fred Upton (R-MI), added an additional $8 billion over five years to help defray the increased costs of individuals with preexisting conditions, adding to the $130 billion allocated in the original AHCA text. These funds would be available for states establishing high risk pools to cover individuals with anticipated higher health care costs. Critics estimate that the total funds needed to adequately subsidize high risk pools is $327 billion, assuming 1.5 million individuals (5 percent of the small-group and individual markets) would be considered “high risk” due to preexisting conditions and put into the pools. Despite the expected $200 billion shortfall, the Upton amendment was successful in swaying some Republican lawmakers who had previously opposed to the bill.
A separate resolution (H. Res. 2192), excluded from the text of the AHCA due to concerns about its viability in the reconciliation process in the Senate, was passed overwhelmingly in the House. This resolution eliminates the provision within the ACA that requires that members of Congress and their staff purchase insurance through ACA marketplaces. The resolution was offered by lawmakers to close what was seen as a loophole exempting members of Congress and their staff from the requirements of the AHCA, if it passes in current form.
Shortly after the roll call vote passing the AHCA, President Trump hosted lawmakers and executive branch staff, including HHS Secretary Tom Price and CMS Administrator Seema Verma, for a press conference in the White House rose garden. Democrats responded by calling the bill “devastating” to American families, and said it will increase premium costs. House Minority Leader Nancy Pelosi (D-CA) characterized the bill as approaching health care as a privilege for the wealthy.
Now the bill moves to the Senate, where Senators from both parties have said that any bill coming out of their chamber will be significantly different from the House-passed AHCA. The majority held in the Senate by Republicans is razor thin; losing just three votes means defeat of a measure. Assuming the AHCA can pass muster as a filibuster-proof reconciliation bill, it still must get at least 50 votes, assuming Vice President Pence would cast a tiebreak vote in favor. Senator Lamar Alexander (R-TN), who heads the influential Senate HELP committee, has for months talked about the need to thoughtfully repair the health care system, rather than repealing the ACA without an adequate replacement. Several Senators, including John Cornyn (R-TX) and Bob Corker (R-TN), have said that they will take time needed to refine and revise the bill, taking weeks not days to do so.
ANCOR has released a statement on the passage of the AHCA, which is available here.