On March 6, 2017, the House Republican leadership introduced Affordable Care Act repeal and replacement budget reconciliation bills in the Ways and Means (W&M) (summary) and Energy and Commerce (E&C) (summary) committees. The bills, collectively titled the American Health Care Act, are the committees’ responses to the instructions they received in the Budget Resolution passed by both houses of Congress in mid-January to prepare budget reconciliation legislation to repeal the ACA.

What The Two Bills Do, And What They Don’t

Like the leaked bill analyzed here earlier, the two proposed bills do not repeal the ACA. They leave in place the ACA’s titles affecting Medicare, quality of care, program integrity, biosimilars, workforce reform, the Indian Health Service—indeed virtually all of the ACA except for its insurance affordability provisions, individual and employer mandates, taxes, and Medicaid reforms.

More specifically, the legislation does not repeal the ACA’s insurance reforms, such as the ACA’s requirements that health plans

  • cover preexisting conditions;
  • guarantee availability and renewability of coverage;
  • cover adult children up to age 26; and
  • cap out-of-pocket expenditures,

and the ACA’s prohibitions against

  • health status underwriting;
  • lifetime and annual limits; and
  • discrimination on the basis of race, nationality, disability, age, or sex.

Unlike the leaked version, the final bills do not eliminate the essential health benefits provisions (except with respect to Medicaid plans). They do repeal the ACA’s actuarial value requirements and replace the ACA’s three to one age ratio limit with a five-to-one ratio.

 

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