House Republicans on Thursday passed legislation, the American Health Care Act, designed to repeal and replace portions of the Affordable Care Act (ACA), paving the way for a Republican-led effort to reform the healthcare system. However, the legislation faces an uphill battle in the Senate.
The bill passed by a vote of 217-213, one vote more than the majority of 216 required for it to pass. The AHCA represents the Republicans first successful attempt to move forward on a long-held goal of repealing former President Barack Obama’s healthcare reform bill, which was passed in 2010. Twenty Republicans crossed the aisle to vote against the bill along with Democrats.
Passage of the healthcare bill comes six weeks after House leaders, short of votes, withdrew an earlier version of the AHCA from the House floor.
The bill repeals the core elements of the ACA, including tax penalties for people who go without health insurance as well as subsidies to help people get insurance coverage. Last-minute changes to the newest version of the bill added $8 billion in funding to help cover people with pre-existing medical conditions. However, many Democrats and other critics of the bill say the $8 billion funding is not enough to protect patients with pre-existing conditions.
According to a New York Times article, the bill would make profound changes to Medicaid, the health program for low-income people, ending its status as an open-ended entitlement. “States would receive an allotment of federal money for each beneficiary, or, as an alternative, they could take the money in a lump sum as a block grant, with fewer federal requirements. The bill would also repeal many of the taxes imposed by the Affordable Care Act on high-income people, insurers and drug companies, among others,” according to the article.
Back in March, as reported by Healthcare Informatics, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released its analysis of the earlier version of the AHCA and said the bill would reduce federal deficits by $337 billion over the next 10 years and increase the number of people who are uninsured by 24 million in 2026, relative to current law. The nonpartisan CBO’s score of the AHCA indicates that the largest savings from enacting the AHCA would come from reductions in outlays for Medicaid and from the elimination of the ACA’s subsidies for non-group health insurance. The bill would cut Medicaid spending by $880 billion between 2017 and 2026, according to the CBO analysis.
The House vote on Thursday took place before the CBO released a new cost and impact analysis of the revised bill.
Many healthcare industry organizations have voiced opposition to repealing the ACA, and to the replacements in the AHCA. American Medical Association (AMA) president Andrew Gurman, M.D., said in a statement Wednesday that the proposed changes to the bill, such as the $8 billion in additional funding, would not change the “serious harm to patients and the health care delivery system if AHCA passes.” He further stated, “Proposed changes to the bill tinker at the edges without remedying the fundamental failing of the bill – that millions of Americans will lose their health insurance as a direct result of this proposal.”
While there is a long road ahead before the bill might head to President Trump's desk, Chas Roades, chief research officer at The Advisory Board, a Washington, D.C.-based healthcare consulting firm, offered his perspective on how the bill's potential passage should, and shouldn't, affect healthcare provider strategy. "First, the revised bill passed today likely still would negatively impact provider finances through a combination of cuts to Medicaid and reduced coverage in the individual market. Secondly, the bill faces an uncertain future in the Senate and—even if it does eventually pass—is highly likely to be significantly modified to comply with Senate rules and garner sufficient support. And for providers, passage of the AHCA underscores the need to double down on efforts to improve efficiency, elevate performance, and expand patient access."
Health and Human Services (HHS) Secretary Tom Price, M.D., who was picked by President Donald Trump to lead HHS, praised the House's passage of the AHCA. “The status quo is failing the American people. Premiums are skyrocketing; choices are narrowing or vanishing; and patients do not have access to the care they need. Today, the House of Representatives has begun to deliver on President Trump’s promise to repeal a broken law and replace it with solutions that put patients in charge. This is a victory for the American people,” he said in a statement.
Further, Price stated, “The American Health Care Act is focused on patients. It is the first step toward a patient-centered healthcare system that will provide Americans access to quality, affordable healthcare coverage, empowering individuals and families to choose the coverage that best meets their needs, not what Washington forces them to buy, and equipping states to address the diverse needs of their most vulnerable populations. As Congress continues its work, the team at HHS will continue to support the reform effort by reviewing and initiating administrative actions to put patients, families and doctors in charge of medical decisions, bring down costs, and increase choices.”
Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, also tapped by President Trump to lead the agency, said in a statement that the bill that was passed today is a great first step to achieving the goal of "a more affordable, more sustainable healthcare system.”
“Today is the first of what I am confident will be many historic days ahead as we move toward patient-centered healthcare instead of government-centered healthcare. I have worked in the field of Medicaid for 20 years and have heard from many mothers like myself who have shared their struggles and their hopes for a more affordable, more sustainable healthcare system. It is important that our most vulnerable citizens, the aged, the infirm, the blind and the disabled have more choices, greater access and peace of mind when it comes to their healthcare.”
In his statement issued Wednesday, AMA President Gurman also addressed the idea of states setting up so-called “high-risk pools.” “Prior to the enactment of the Affordable Care Act, 35 states operated high-risk pools, and they were not a panacea for Americans with pre-existing medical conditions. The history of high-risk pools demonstrates that Americans with pre-existing conditions will be stuck in second-class health care coverage – if they are able to obtain coverage at all. Not only would the AHCA eliminate health insurance coverage for millions of Americans, the legislation would, in many cases, eliminate the ban against charging those with underlying medical conditions vastly more for their coverage.”
On the House floor before the vote, House Minority Leader Nancy Pelosi (D-California) said the AHCA would force families to pay higher premiums and deductibles and would result in higher costs, less coverage and would take away insurance coverage from 24 million Americans. “This bill is gutting key protections, maternal care, emergency care, prenatal care, it guts protections for Americans with pre-existing medical conditions,” she said. And, she said, “Today is a ‘great civics lesson.’ Why? Voters will find out who their congressmen are—and who's taking away their healthcare.”
Many Republican supporters of the bill say that if it becomes law it will help to stabilize the insurance exchange markets. House Speaker Paul Ryan (R-Wisconsin), speaking on the House floor before the vote, referenced news that one of the last health insurance companies selling plans through the ACA exchanges in Iowa would be exiting the market. “Iowa is down to one insurer; that is not a choice. Now that one insurer is pulling out of 94 of 99 counties in Iowa. Tens of thousands of Iowans go from one option to no options. This is a crisis, this is happening right now. What protection is Obamacare, if there is no insurance plan to purchase in your state?”
“This bill will give people more choices and more control over their care, and make insurance companies come in and compete for your business, restore power from Washington to the states, this bill does all of those things. It delivers on the promises we have made to the American people. We have been waiting seven years to cast this vote to repeal and replace Obamacare and to rescue people from this collapsing law," Ryan said.