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

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.

GOP leadership may also face opposition from Senator Susan Collins, R-Maine, who has not been happy with Republican plans to defund Planned Parenthood. AHCA prohibits funds to organizations that primarily engage in family planning services, reproductive health, and related care, as well as those that provide abortions, except in cases of rape or incest or where the woman’s life is in danger.

“‘Defunding’ Planned Parenthood would block millions of people in this country from accessing birth control, cancer screenings, and preventive care,” Cecile Richards, president of Planned Parenthood Federation of America, said in a statement on Tuesday. “For many patients, Planned Parenthood is the only health care provider they see. Blocking access to care at Planned Parenthood hurts communities that are struggling to get by the most, especially those with low incomes, those living in areas with no other quality health care providers, and communities of color who face systemic barriers to care.”

In addition, Republicans who don’t feel the bill goes far enough may cause trouble. Senator Rand Paul, R-Kentucky, has been very vocal that any bill should fully repeal the ACA, and anything less would be unacceptable since Republicans ran on the platform of repealing the law.

“We call on Congressional leaders to keep their word to the American people, to push a real repeal of ObamaCare, and to do it now,” Paul wrote in a joint op-ed with Congressman Mark Meadows, R-North Carolina. “The only way to really do that in a way that ensures passage is to move forward with a "clean" repeal, such as the 2015 repeal bill.”

With only 52 Republicans to 48 Democrats in the Senate, losing just 3 of those who already have concerns with the bill would be enough to prevent the bill from passing.

Avik Roy, president of the Foundation for Research on Equal Opportunity, wrote in a Forbes opinion piece that while the bill has good ideas, its “reforms are overshadowed by the bill’s stubborn desire to make health insurance unaffordable for millions of Americans, and trap millions more in poverty.”