Yesterday, the American Health Care Act (AHCA), legislation to repeal the Affordable Care Act (ACA), cleared another hurdle when the House Budget Committee voted to advance the bill to the Rules Committee by a vote of 19–17, despite three members of the House Freedom Caucus voting against it. Reps. Mark Sanford (R-SC), Dave Brat (R-VA), and Gary Palmer (R-AL) all voted no, claiming the bill is not conservative enough. A number of Republican Senators have said they would not vote for the legislation in its current form—some opposing the legislation for not completely repealing the ACA and others because they fear it goes too far. Several Republican House members also oppose the legislation in its current form due to the potential increases in uninsured citizens. Democrats in both the House and the Senate are primarily concerned about cuts to Medicaid funding and the number of Americans likely to lose health coverage if the bill is enacted. It is likely that the bill will be amended before final passage in the House after President Trump and HHS Secretary Tom Price, MD, responded to these concerns, noting the changes may involve Medicaid and tax credit provisions.
Concerns about the AHCA bill increased after Monday’s release of the Congressional Budget Office (CBO) cost estimate. According to the CBO cost estimate, which can be read in its entirety here, the AHCA would bring a $337 billion reduction in deficit spending over a 10-year period. The largest savings would come from reductions in outlays for Medicaid and from the elimination of the ACA’s subsidies for nongroup health insurance. However, 14 million more Americans would be uninsured by 2018 than under the current law. By 2026, that number increases to 24 million. Of those who are covered under employer plans, 2 million people would lose their coverage compared to current projections for 2020, while 7 million would lose employer coverage by 2026. Tax credits for lower-income people would be less under the AHCA than current law since the new tax credits are solely age-adjusted. Despite receiving a larger tax credit under the proposed law, older Americans’ premiums would be up to 5 times higher than those for younger individuals.
Even before President Trump and Secretary Price promised changes, the AHCA was likely to be altered before the full House vote due to opposition from both sides of the aisle, as well as multiple stakeholders, including medical organizations, such as the American Medical Association (AMA) and the American Hospital Association (AHA), and at least four Republican governors concerned about Medicaid funding.
If the AHCA clears the Rules Committee, the next stop would be the full House vote—likely next Thursday—before heading to the Senate. Senate Majority Leader Mitch McConnell (R-KY), who supports the House bill, wants the Senate to take a final vote on the legislation in April. We will keep you updated.