Republicans Announce Amendment to AHCA

On April 25, 2017, Republican leaders within the U.S. House of Representatives released a copy of what is being called the MacArthur Amendment. The proposal signals the Republicans’ intention to move forward with a revised American Health Care Act (AHCA). The amendment, sponsored by Tom MacArthur (R-NJ), would keep certain ACA provisions in place such as the prohibition on pre-existing condition exclusion periods, the prohibition on gender discrimination in premium rating, no cost sharing for certain preventive care services and coverage for children to age 26.

The amendment would provide states with greater flexibility in terms of premium rating based on age and health status; and essential health benefits.

Under the proposed plan, states would be able to apply for a waiver that would:

  • Allow non-grandfathered individual and small group health plans to charge premiums higher than the 5:1 age ratio provided by the AHCA if the state’s waiver application is approved (for plan years starting on or after Jan. 1, 2018);
  • Allow states to define their own essential health benefits (for plan years starting on or after Jan. 1, 2020); and
  • Allow individual health plans to charge a higher premium to individuals based on health status, but only if the state provides financial assistance for high-risk individuals or participates in a high-risk pool.

To pass the House, the bill would need 216 votes. The bill would still pass even if 22 republicans failed to support the bill (assuming all other representatives voted along party lines). It is unclear at this time if the Republicans have enough votes for the bill to pass and to proceed to the Senate. Congress has other priorities this week including discussions on tax reform and a vote on the budget to avoid an impending government shutdown.

We will continue to keep you updated on any developments.

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