Tonight, the House Rules Committee released the near final version of the American Health Care Act of 2017. This version makes key changes to the bill to attract wayward moderates and conservatives – the latter being more an issue than the former.
These changes are:
- Moves end of Medicaid expansion from Dec. 31, 2019 to Dec, 31, 2017 but preserves right of states to continue to cover Medicaid expansion enrollees at the state’s regular FMAP (50 to about 75 percent).
- Grandfathers people who enroll in expansion prior to Dec. 31, 2019 with current enhanced match.
- Changes the enhanced FMAP for Medicaid expansion by limiting it to states that had already expanded as of March 1, 2017. States that wish to expand enrollment to childless adults would receive the State’s regular FMAP
- Provides for an optional work requirement for childless adults who wish to enroll in Medicaid with some limitations
- Increases the per capita inflation factor from CPI-U for Medical Care to CPI-U+1 for aged and disabled enrollees
- Prohibits New York State from using contributions from counties to enhance their federal Medicaid matching dollars.
- Allows for use of block grants by states that elect to do so. Block grant funding shall be calculated by computing the per capita cost of the eligible population, multiplied by the number of enrollees. The block grant will inflate on CPI but will not adjust for changes in population. Unused funds would rollover and remain available to the state in subsequent years.
- Creates a the $1B American Health Care Implementation Fund to carry out such provisions like per capita allotment for medical assistance, the Patient and State Stability Fund, additional modifications to premium tax credit and a refundable tax credit for health insurance coverage.
- Adds another year of delay for the Cadillac tax.
- Makes repeal of taxes effective at the beginning of 2017.
There is a lot to like about this bill if you are a Governor - unless you are the Governor of New York. The additional flexibility to control enrollment and scope of services has been long sought by Governors blue and red. The effective date of repeal of the taxes will appeal to moderates and conservatives. The question remains if treatment of tax credits and their impact on the 55-64 set will be acceptble esepcially in the more, how shall we say, seasoned Senate.
We will dig in to it tonight and tomorrow and probably have more to say. You can read amendments and section by section summaries on the House Rules page: https://rules.house.gov/bill/115/hr-1628
Call with questions.
Emily Evans
Managing Director
Health Policy
