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House GOP's ACA Replacement Bill Repeals Individual Mandate, Rolls Back Medicaid Expansion

Laura Joszt
After weeks of leaked drafts and secret, closed door meetings, House Republicans have released the American Health Care Act, their bill to replace former President Barack Obama’s Affordable Care Act.
After weeks of leaked drafts and secret, closed door meetings, House Republicans have released the American Health Care Act (AHCA), their bill to replace former President Barack Obama’s Affordable Care Act (ACA). The bill is not a full repeal of the ACA. In addition, it contains no estimates for how much it would cost nor the number of Americans who could gain or lose insurance coverage.
 
The bill keeps popular patient protections, including prohibiting insurers from denying coverage to patients with preexisting conditions and allowing young adults to stay on their parents’ plan until age 26.
 
“Obamacare is rapidly collapsing,” House Speaker Paul Ryan, R-Wisconsin, said in a statement. “Skyrocketing premiums, soaring deductibles, and dwindling choices are not what the people were promised seven years ago. It’s time to turn a page and rescue our health care system from this disastrous law. The American Health Care Act is a plan to drive down costs, encourage competition, and give every American access to quality, affordable health insurance."
 
Importantly, AHCA does away with the individual mandate so Americans will not be penalized for not having health insurance. Instead, it encourages people to maintain continuous insurance coverage or be penalized. People who don’t maintain continuous coverage beginning with the plan year 2019 can be charged a 30% premium increase
 
The replacement bill includes a repeal of Medicaid expansion, ending the expanded program for states on December 31, 2019, and converts its funding to a per capita mechanism. This is a shift away from the initial GOP proposal to change Medicaid into a block grant program. Four Republican senators had come out just before AHCA’s release to state that the Medicaid expansion population needs to be protected.
 
Senators Rob Portman, R-Ohio; Shelley Moore Capito, R-West Virginia; Cory Gardner, R-Colorado; and Lisa Murkowski, R-Alaska, sent a letter to Senate Majority Leader Mitch McConnell on Tuesday.
 
“While we support efforts to repeal and replace the Affordable Care Act and make structural reforms to the Medicaid program, we are concerned that the February 10th draft proposal from the House of Representatives does not provide stability and certainty for individuals and families in Medicaid expansion programs or the necessary flexibility for states,” they wrote.

A growing number of Republican governors are also calling for Medicaid expansion to remain in place. Ohio Governor John Kasich is working with other Republican governors to keep the ACA-level funding for Medicaid expansion at least at 100% of federal poverty level.
 


 
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