ACA Repeal Watch- Some Interesting Updates While Awaiting Senate Bill

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    Whitfield L. Knapple, MD, FACG
    Chair, ACG National Affairs

    According to a report released this week by the Centers for Medicare and Medicaid Services, the House-passed American Health Care Act (AHCA) would leave 12.6 million more Americans uninsured over the next decade, and reduce federal spending by $328 billion.   This estimate is well below the 23 million more uninsured that the Congressional Budget Office (CBO) estimated in its May report.

    “Taken together, we estimate that there will be 35 million uninsured in 2020 under the AHCA, a figure that is about 8 million higher than under current law. By calendar year 2026, the number of uninsured is estimated to increase from 31 million under current law to more than 43 million under the AHCA, an increase of roughly 13 million. The percentage of the U.S. population with health insurance coverage is estimated to decrease from 91.3 percent under current law in 2026 to 87.7 percent under the AHCA.”

    It is very unlikely that the House-passed AHCA will be passed in Senate, however, as the Senate is developing their own plan.  As of now, Senate Republicans have yet to release this plan despite having the goal of a vote in July.  Senate Minority Leader Chuck Schumer (D-NY) released a letter to Majority Leader Mitch McConnell (R-KY) this week, serving as an invitation for a meeting with all Senators from each party to discuss the plans to repeal the Patient Protection and Affordable Care Act (ACA).  In his letter, Schumer called for an “open and robust debate” that would allow for every senator, rather than a select few, to have a voice in this important discussion on the future of U.S. health care.

    The CMS report also highlights ACG’s concerns with the AHCA regarding cost-sharing and changes to Essential Health Benefits (EHBs):

    • The CMS report highlights the possibility that some states could obtain waivers under the AHCA that severely limit what benefits must be covered, or allow insurers to charge higher premiums for people with expensive medical conditions. “If such actions were implemented, we would expect that the individual market in these areas would destabilize such that the premiums for comprehensive coverage for a significant proportion of the population would become unaffordable and the coverage would cease to be offered.”
    • For the individual insurance market, average gross premiums are estimated to be roughly 13% lower in 2026 under the AHCA than under current law. However, average net premiums (after Federal and State subsidies) would be roughly 5% higher than under current law. Estimated average cost-sharing amounts are projected to be roughly 61% higher in 2026 under the AHCA than under current law. These estimates vary, as age, income, and depending on whether the enrollee resides in a State that applies for waivers for EHBs or community rating would all be factors.

    ACG is actively engaging lawmakers on these patient protection and coverage issues, and will continue to update membership on ACA repeal developments.

    Whitfield L. Knapple, MD, FACG

    Chair, ACG National Affairs Committee

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