This week we saw the health care reform debate heat up, with House Republicans releasing their plan, the American Health Care Act on Monday
. At this point it is not clear that the proposed legislation will overcome the ACA's greatest shortcoming: making care more affordable.
Tax credits for purchasing insurance on the individual market and measures to incentivize Health Savings Accounts seem to form the twin pillars of this proposal, which keeps much of the ACA in place. Three ACA provisions that will remain intact are: (1) eliminate the use of pre-existing conditions in underwriting, (2) allow children to stay on a parent's policy until age 26, and (3) ban the use of lifetime maximum coverage caps. The ACA value-based purchasing programs also appear to be left in place.
Taking steps away from the ACA, the Republican plan removes the mandate for individuals or employers to purchase health insurance and the penalties set forth in the ACA for non-coverage. In order to protect insurers from the adverse selection that can accompany guaranteed access to insurance, those with gaps in coverage would be subject to 30% premium surcharges. Rate bands which differentiate the price between younger and older subscribers have been expanded. The "Cadillac" tax, which would impose taxes on employers who offer rich plans, has been delayed until 2025; however, its future seems uncertain.
Medicaid expansion will be able to remain in place through 2020, after which federal funds for new Medicaid enrollees will stop. States will be given flexibility in structuring their Medicaid programs and the current spending match will be replaced with a per capita allotment, without adjustments for high spending communities. High risk pools will return.
If the early response is any indication, consensus will not come easily. What do you think? We look forward to learning your opinions.
BHC Executive Director