The Budget Reconciliation Process H.R. 1628 American Health Care Act of 2017
By: Robert Pusateri, Capstone Brokerage Benefits Consultant, June 5, 2017
Years ago, the Democrats used budget reconciliation to enact parts of the Affordable Care Act (ACA), so the use of reconciliation to modify the ACA but not repeal it is fitting.
Republicans don’t have the number of votes to pass the AHCA by standard process. Most likely it will be filibustered by the Senate Democrats. Republicans are using the “budget reconciliation” process instead to move their bill forward from the House to the Senate vote. Budget reconciliation makes one bill each year immune to a filibuster in the Senate, and the AHCA is this year’s bill. Budget reconciliation can only be used on some types of bills that affect the federal budget, limiting provisions that can be included in the AHCA. A full repeal of the ACA wouldn’t be permitted under reconciliation rules. The reconciliation process also requires the House Budget committee to formally introduce the bill after it goes through committee. Likely why the AHCA was revealed to the public on March 6, 2017 as a beginning draft and only formally introduced as a bill in Congress on March 20,2017.
There are of course similarities between how the Affordable Care Act was enacted and what is happening now with the AHCA; there are also significant differences. The ACA was enacted after an enormous debate on competing and policy proposals for nearly 12 months.
Senate Republicans released their draft of health care reform which is only 142 pages on June 22nd, 2017. The draft legislation, called the Better Care Reconciliation Act of 2017 (BCRA), would replace the health care bill text proposed by House Republicans if the Senate passes it.
The American Health Care Act of 2017 (AHCA), also known as the Better Care Reconciliation Act of 2017 (BCRA), is the leading proposal to “repeal and replace” the Affordable Care Act (aka Obamacare) and “defund” Planned Parenthood.
A new deal among the Republicans were reached. The changes to the AHCA, as reported by the Rules Committee, are:
• States may opt-out of providing the ACA’s essential health benefits. (This requirement was already dropped in the bill for Medicaid but not for the individual market.)
• States may opt-out of requiring premiums to be the same for all people of the same age, so while individuals with pre-existing conditions must be offered health insurance there is no limit on the cost of that insurance. A new $8 billion fund would help lower premiums for these individuals.
• States may opt-out of limiting premium differences based on age.
• There would be a new $15 billion fund for risk sharing to help states lower premiums.
Subscribers Covered on an Employer’s Plan
• Fines would be eliminated for large employers that don’t provide health plans.
• Small-business tax credits would end in 2020.
Subscribers Covered on an Individual Plan
• The ACA limited what health insurance providers could charge in premiums. Under the AHCA, those limits would be adjusted so that younger people might see lower premiums and older people much higher premiums.
• The ACA’s complex cost-sharing provisions that lowered costs for some low-income Americans would be eliminated.
• The ACA’s metallic plan options ( bronze/silver/platinum levels ) would be eliminated.
Medicaid Subscribers
• The ACA expanded Medicaid eligibility in 32 states that opted in to it. The AHCA would reverse the eligibility expansion beginning in 2020 (anyone enrolled by then would remain enrolled), and it would reduce federal support for Medicaid with caps on coverage.
• The ACA expanded required benefits under Medicaid, such as mental health and addiction services, which would no longer be required.
Planned Parenthood
The AHCA would also prohibit federal funding from going to Planned Parenthood, mostly through Medicaid, for one year.
Even in 2017 despite controlling both the legislative and executive branches, and having previously voted successfully 40+ times in the House to repeal the ACA, the Republicans’ AHCA is definitely not a finished deal.
No Democrats will likely support the AHCA or BCRA. The ACA also has all-time high support from the American public, with support reaching 54 percent last month. It is going to be interesting to watch and see what the outcome will be.
