The American Health Care Act – Version 1.0



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Carl S. Beattie
American Health Law Association
March 13, 2017

On March 6, House Republicans unveiled an initial version of the American Health Care Act, the highly anticipated legislation designed to repeal and replace significant aspects of the Affordable Care Act. Comprised of a pair of bills introduced in the Energy and Commerce Committee and the Ways and Means Committee, the proposed AHCA cleared both committees Thursday night through party-line votes and is now headed to the Budget Committee for continued review.

As anticipated, the legislation will proceed under the budget reconciliation process that was initiated by the Senate in a party-line vote on Jan. 12. The reconciliation process will allow the AHCA’s proponents to take advantage of certain streamlined procedural rules, most notably in the Senate, where reconciliation measures cannot be filibustered. The procedural luxuries come at a price, as reconciliation measures generally must be limited to matters that affect government spending and taxation. Nonetheless, the AHCA would implement an ambitious list of changes:

The House bills would leave in place a few popular elements of the ACA; most notably, the rule allowing children to stay on their parents’ health insurance until age 26 and the protections against denials of coverage for preexisting conditions. Those components are beyond the reach of what Congress can repeal through budget reconciliation legislation. It was widely expected that they would be spared from the GOP repeal efforts because of their significant public support. The insurance exchanges established under the ACA would also remain, although many of the changes may bring their continued viability into question.

Despite the streamlined budget reconciliation process, the AHCA is certain to face many challenges, several of which began to emerge within the first 24 hours after the bills' unveiling:

The AHCA is likely to be followed by more salvos from Congressional Republicans aimed at other aspects of health care reform. Certain aspirational GOP policies, including medical malpractice reforms and rule changes that would allow insurers to sell across state lines, are not included in the AHCA and are beyond the scope of what can be done through the budget reconciliation process.

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