Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


Republicans Release Text of Amendment to AHCA

House Republicans unveiled a new, amended version of the American Health Care Act (AHCA) last week. The latest draft was negotiated between centrist Rep. Tom MacArthur (R-N.J.) and conservative Rep. Mark Meadows (R-N.C.). The bill now includes an amendment from Rep. MacArthur, which would give states the ability to waive certain Obamacare insurance regulations, including the ability to charge people with pre-existing conditions more for coverage, as long as an alternative like high-risk pool coverage was offered. The amendment would also allow states to waive the essential health benefit requirements, as well as restrictions on how much more insurers can charge older people than younger people. In order to receive a waiver, states would have to meet one of a list of possible criteria, including reducing premiums, increasing coverage, increasing choice of plans, stabilizing the market, or stabilizing premiums. Waivers would be approved by default unless rejected by the Secretary of the U.S. Department of Health and Human Services (HHS) within 60 days. The revised bill earned the support of the conservative House Freedom Caucus, who believe that the Affordable Care Act’s (ACA) insurance regulations are responsible for rising premiums. But in gaining the support of conservative Republicans, the changes may have caused additional defections among moderates who supported the earlier version of the bill. A vote on the legislation has not yet been scheduled. President Trump expressed disappointment in the proceedings, having pushed for a vote on the bill before Saturday, which marked his 100th day in office. The President later indicated that a vote could take place as early as this week. House leadership has stated that they will schedule a vote on AHCA when they are confident the bill has enough support to pass. Republicans can only afford to lose 22 votes from their own caucus for guaranteed passage. A number of lawmakers, including House Rules Committee Chairman Pete Sessions (R-Texas), have expressed doubts that the MacArthur amendment would secure enough votes for passage in the House. At least 21 Republicans have expressed opposition to the revised measure, with many more still undecided. Rep. MacArthur has said that he is open to making changes to the bill to gain the support of more moderates, but it is unclear what those changes might entail. The Government Accountability Office (GAO) has said that a score of the bill including the MacArthur amendment will not be ready either this week or next. Moderate Republicans are likely to be hesitant to vote on the legislation without an updated analysis of the bill’s cost and impact on enrollees. It remains unclear whether the revised bill could pass the Senate’s rules for reconciliation, and members from both chambers and both sides of the aisle have questioned whether passage in the upper chamber would be possible given its lukewarm reception by Senate Republicans. The latest legislation has been formally opposed by the American Medical Association (AMA), due to concerns that the proposed changes could result in the loss of coverage for millions of Americans while making coverage unaffordable for patients with preexisting conditions. The modified AHCA has also been opposed by the AARP, in part because it would allow insurers to charge older Americans up to five times more than younger Americans.

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