As passed by the House of Representatives, the bill would eliminate tax penalties from the ACA and it removes tax increases on high earners and the health industry, cuts Medicaid expansion for low-income people, allows states to pass work requirements on Medicaid recipients, and it removes subsidies that were dependent on income and premium cost and replaces them with age dependent tax credits. The new bill still requires family policies to cover children until age 26.
The bill was strongly opposed by numerous professional medical organizations including the American Medical Association, American College of Physicians, American Cancer Society, Mental Health America, Physicians for Reproductive Health and the American Diabetes Association. The majority of the concern was regarding an amendment to the bill by NJ Representative Tom MacArthur that would allow states the ability to opt-out of the ACA’s list of essential health benefits (including maternity and mental health care), allow insurers to charge people with pre-existing conditions significantly higher rates than “healthy” customers, and allow for increased premiums for older consumers.
Insurers will not be able to deny coverage to people with pre-existing conditions but insurers can increase the premiums if continuous coverage is not maintained. There is also a 30% surcharge in the premium if there is a gap in coverage. The Patient and State Stability Fund will provide states with funding to create high-risk pools. A recent AARP study found premiums could exceed $25,000 per year for these pools, preventing patients from being able afford care while still providing access. The bill has $138 billion earmarked for the pools over the next ten years but experts have concluded it will not be enough even with an additional $8 billion allocated at the last minute.
Tax credits will be reduced for most people under the AHCA bill. The credits start to decrease for single filers earning $75,000 and joint filers earning %150,000. Although tax credits increase with age in the AHCA, the structure favors the young. According to CBO predictions based on the original plan, a 64 year old making $26,500 would pay $19,500 in premiums under the new bill as compared to $15,300 under the ACA. When including subsidies, under AHCA the patient would pay $14,000 out of pocket compared to $1,700 under the ACA.
The bill also includes an amendment preventing members of Congress from being exempted from the AHCA. Since the bill has been rushed, the CBO has not had a chance to score the amended version of the bill.