AHCA Faces House Vote

WHA continues to weigh in

March 24, 2017

Late breaking news: Following publication of The Valued Voice today, WHA learned House Republican leaders canceled today’s planned vote on the American Health Care Act (H.R. 1628), legislation to repeal and replace parts of the Affordable Care Act (ACA). According to the American Hospital Association, the prospects of future congressional action addressing the ACA are uncertain at this time.

After imposing substantive modifications, the U.S. House delayed their vote on the American Health Care Act (AHCA) bill, originally scheduled March 23. As of the time of this writing, the bill was expected to be voted on today (March 24). 

On March 20 and throughout the week, several substantive changes to the bill were announced in attempts to earn the votes of some House members. And on March 23, the Congressional Budget Office (CBO) released a new score for the bill, taking into account some but not all of the changes to the bill that were still being negotiated that night. However, the latest CBO score still projects the bill will result in an additional 24 million uninsured by 2026.

None of the changes to the bill have fixed the inequities for states like Wisconsin. WHA has been vocal in its priority that the coverage gains achieved here through Gov. Scott Walker’s “Wisconsin Model” must be sustained. See Wisconsin Health News article

WHA President/CEO Eric Borgerding appeared on WisconsinEye March 22 to discuss the AHCA. Borgerding described the latest developments with the AHCA and emphasized WHA’s concerns with the current version of the bill for Wisconsin.

Wisconsin expanded coverage to about 130,000 childless adults, without receiving higher federal funding like many other states did. At the same time, Wisconsin reduced Medicaid eligibility for about 60,000 adults in 2014, relying on income-based subsidies being available for low-income Wisconsinites to obtain private coverage. 

Under the bill, Wisconsin could receive an estimated $70 million in “safety net” funding. But under Wisconsin’s model for coverage, Wisconsin is spending about $280 million in state dollars for a population group for which other states get full federal funding. 

“Wisconsin (is) being penalized for rejecting Obamacare in a bill that repeals Obamacare,” said Borgerding. 

Following up to his WisEye interview, Borgerding sent a letter to Gov. Scott Walker outlining WHA’s concerns that the Wisconsin Model of coverage is not recognized and that the AHCA “perpetuates the ACA’s inequities.” 

While the bill allows states that had expanded Medicaid to keep their expansion and the higher federal dollars that go with it through 2020 and even further for some recipients, a new amendment this week prevents new states from expanding their programs and receiving the same federal funding. 

By contrast, in his letter to Walker, Borgerding indicates WHA’s support for a proposal put forth by the Republican governors from Ohio, Michigan, Nevada and Arkansas. They have suggested that states should be allowed to expand coverage to a level below the Obama Administration’s definition and still receive enhanced federal funding.

“This approach essentially redefines the Obamacare standard of ‘expansion’ and finally recognizes and equitably funds the Medicaid expansion Wisconsin implemented when we added some 130,000 childless adults below 100 percent FPL to our program,” Borgerding wrote. 

In other provisions, one new amendment to the bill this week would repeal the “essential health benefits” requirement imposed by the ACA that requires insurance plans to include certain minimum benefits. Proponents of this provision believe this will allow insurers to offer more affordable coverage, but it also raises concerns about whether the coverage purchased will be sufficient. 

Other amendments to the bill throughout the week attempt to address some concerns particularly for older Americans. One change increases the inflationary factor for the per capita allotment for the elderly and disabled populations. This was a partial nod to the concerns raised by the CBO that the federal funding for Medicaid would fall short of keeping pace with cost growth. This is a positive step, as this is the population group with the highest per capita spending in the program. 

As of the time of this writing, the House is continuing its discussions with the bill set to go to the Floor today, March 24. If passed, the AHCA will then go to the Senate where we expect more opposition, but also opportunities to affect change.

This story originally appeared in the March 24, 2017 edition of WHA Newsletter