It’s hard to keep up with all the health care legislation news lately. That’s why we’re providing regular summaries of the latest news, reflecting the current state of health care in the United States or how it may be changing in the not-too-distant future. Here’s a recap of some of this week’s stories:
House Republicans Release American Health Care Act
On March 6, House Republicans released their highly anticipated, and long-awaited, plan to repeal and replace the Affordable Care Act (ACA).
The legislation, titled the American Health Care Act (AHCA), maintains many provisions of the draft legislation leaked in February, but with modifications such as the addition of income-based phase-outs for the new health care coverage tax credit, delayed effective dates for key provisions, and the removal of a provision that was compared to the “Cadillac tax” on high-cost employer plans. As anticipated, the expansion of HSAs is a key component of the Republican plan (see below for more information).
As expected, the AHCA would repeal nearly all of the ACA, including the individual mandate, the employer mandate, the premium tax credit, the net investment income tax credit, the Medicare tax credit, the small employer health insurance credit, and the limitation on health flexible spending account (FSA) contributions.
While the Cadillac tax is currently scheduled to go into effective in 2020, the AHCA would not repeal it, but instead further delay its effective date. Popular features of the ACA including the ban on discriminating against people with pre-existing conditions and the provision that allows young adults to stay on their parents’ plan through age 26 remain in place with the new legislation.
The hallmark of the AHCA’s ACA replacement is a new refundable tax credit for health insurance coverage, replacing the ACA’s subsidies to offset the cost of insurance. The new tax credit would range between $2,000 and $4,000 per individual, increasing with a person’s age and family size.
The AHCA generally retains Medicaid expansion through December 31, 2019. At that point, people who had enrolled pursuant to the ACA expansion provisions can remain in the program (with continued federal subsidies) if they remain eligible, but the eligibility standards would generally revert to the way they were before ACA. The AHCA would also shift Medicaid funding so as to cap the amount that each state receives from the federal government on a per-capita basis.
HSA Expansion a Key Pillar of the American Health Care Act
HSA expansion is a central element of the Republican agenda to make health care more consumer centric. So it came as no surprise to see the expansion of HSAs a key pillar of the American Health Care Act, released by House Republicans earlier this week.
The HSA reforms contemplated in the AHCA are consistent with HSA reforms previously considered in legislation sponsored by Senator Orrin Hatch (R-UT) and Rep. Erik Paulson (R-MN) as well as other Republican health care reform plans. Specifically, the AHCA would:
- Increase the maximum HSA contribution limit to the maximum out-of-pocket amounts allowed under law;
- Allow both spouses to make catch-up contributions to the same HSA, if both spouses are eligible for catch-up contributions and either spouse has family coverage;
- Provide an administrative fix for expenses incurred prior to the establishment date of an HSA. This fix would correspond the establishment date of the HSA to the date an individual’s coverage under an HSA qualifying plan begins, if the HSA is created within 60-days of the start date of the coverage;
- Permit over-the-counter drugs to be purchased without a prescription;
- Lower the penalty for non-qualified distribution from 20% to 10%; and
- Permit the excess insurance premium tax credit to be deposited into HSAs
House Panels Approve American Health Care Act
After a marathon 18 hours of debate, the House Ways and Means Committee passed the American Health Care Act (AHCA) on Thursday, March 9th, by a 23-16 party line vote. Despite numerous attempts by Democratic committee members to amend the legislation, the AHCA was passed by the Committee without any changes. The Ways and Means Committee has jurisdiction over the tax-related provisions of the measure.
As the Ways and Means Committee were undergoing its markup of the measure, the House Energy and Commerce was also considering the AHCA.
The measure was approved by the Energy and Commerce Committee after 24 hours of debate and was approved by a party-line vote.
Next stop for the legislation is the House Budget Committee, after which the legislation will go the House Rules Committee. Republican House leadership is targeting a floor vote on the AHCA within a few weeks.