Tweaks To The AHCA Potentially Revive ACA Repeal And Replace Efforts

Miranda Franco is a senior policy advisor in Holland & Knight's Washington, D.C., office.

In March 2017, Speaker Paul Ryan announced that the House would not vote on the American Health Care Act (AHCA) because it appeared there was not sufficient support to pass the legislation. Members of the conservative House Freedom Caucus opposed the bill because they felt it did not do enough to repeal the Affordable Care Act (ACA). However, some moderate GOP members were concerned with the bill's impact on coverage.

Following the legislative setback, Republicans are attempting to determine their next steps. Accordingly, White House officials on April 3, 2017, met separately with moderate and conservative Republicans to discuss potential changes to the ACA repeal legislation that may open the door to reviving the bill. White House officials floated proposals that would allow states to request waivers to opt out of the ACA's community rating provision, which prevents insurers from charging sick consumers high premiums and the essential health benefits provision, which mandates coverage across ten broad categories.

On April 6, 2017, the House Rules Committee advanced another provision in an impromptu meeting. The Committee voted 9-2 to adopt an amendment that creates a risk-sharing fund. The amendment was offered by Gary Palmer (R-Ala.) and David Schweikert (R-Ariz.), members of the Freedom Caucus, and would establish a $15 billion Federal Invisible Risk-Sharing Program from 2018-2026. The program is modeled after Maine's invisible high risk pool. In practice, Maine's pool functioned like a hybrid of a reinsurance program and a high-risk pool. It...