Last night, Politico released a leaked draft amendment to the American Health Care Act that represents the results of negotiations between conservative House Freedom Caucus members and the moderate Tuesday Group.
To no one’s surprise, the amendment would allow states’ to waive certain provisions of the Affordable Care Act:
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State waiver – The amendment permits a state to submit an application to HHS for one or more of the following reasons:
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Beginning with the 2018 plan year, to permit a higher age ratio than the 3:1 prescribed by the ACA
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Beginning with the 2020 plan year, to permit states to establish their own Essential Health Benefits
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Beginning with the 2019 plan year, states may waive the requirements of the AHCA which imposes a premium increase for enrollees who have not maintained continuous coverage. In the alternative, states may permit insurers to use health status as a rating factor for applicants who have not maintained continuous coverage.
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A waiver application will be deemed approved unless the HHS Secretary notifies a state within 60 days of the submission of a complete waiver request.
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The requirements of the waiver request are one or more of the following:
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It will reduce average health insurance premiums in the state
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It will increase health insurance enrollment in the state
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It will stabilize the market for health insurance in the state
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It will stabilize premiums for individuals with pre-existing conditions
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Increase the choice of health plans in the state
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Waivers may be issued for up to 10 years. Renewals will be deemed approved unless the HHS Secretary denies the request within 90 days of its submission.
Not in the amendment? Changes to Medicaid provisions which shift the program to a per capita financing system.
The House’s lack of interest in the making changes to the Medicaid reform program is the result of a number of factors. First, Medicaid reform is a shared goal of moderates and conservatives. The Republican Governors’ white paper proposal makes clear that even they would like to see some change. Second, concerns about whether to mandate a switch to a per capita or block grant system has always been more of an obsession for the Senate. Their election statewide puts them on the same political footing as their Governors back home making them wary of any change that might harm their state’s fiscal position.
And, of course, term limited Governors often cast an ambitious eye toward a Senate seat
The absence, then, of changes to the Medicaid provisions in the AHCA in this House amendment are more a reflection of the lower body’s deference to the Senate’s interest in the topic than agreement on the legislative text.
Does the amendment mean the AHCA passes the House? We say “yes" at the moment.
The reaction so far has been muted. Several members of the House Freedom Caucus are suggesting they would support the compromise. Moderates, so far, have been quiet. There is widespread a sense of fatigue on the whole topic and a strong desire to move on to tax reform even if it means passing a pretty imperfect piece of legislation. Passage means repeal of the ACA can be the Senate's problem for a while.
There are more pressing issues, of course. Funding for the federal government expires Friday evening. So, expect this amendment to percolate for a couple of weeks before leadership considers bringing it to a vote in the Rules committee.
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Emily Evans
Managing Director
Health Policy
@HedgeyeEEvans
