ACA Repeal and Medicaid Restructuring
Last week, the House Budget Committee merged two committee-approved pieces of legislation into a "reconciliation" bill,the American Health Care Act (AHCA), H.R. 1628. (See the March 15 Update for a description of the legislation.) On Wednesday, March 22, the House Rules Committee will meet to decide how the bill can be amended. The bill is expected to move to the House Floor for a vote on (exactly 7 years after President Obama signed the Affordable Care Act into law). If the bill passes the House, Senate Majority Leader Mitch McConnell (R-KY), hopes to bring it up for a vote next week. If it passes the Senate, any differences between the House and Senate bills (theoretically) could be resolved the following week, and the bill could become law by .
IMPORTANT: House Energy and Commerce Committee and House Ways and Means Committee released summaries and the text of their "managers amendments" to the bill (one for technical changes and one for policy changes). The policy amendments would: allow states to receive federal Medicaid funds through a block grant, rather than a per capita cap mechanism, for covering low-income children and/or traditional (non-expansion, non-disabled, non-elderly) adults (i.e., parents and pregnant women); impose a work requirement on "able-bodied adults" without dependents (with certain exceptions); prevent new states from opting in to the ACA's Medicaid expansion; accelerate the repeal of ACA taxes by one year (to 2017); increase the annual inflation rate in per capita caps for the elderly and disabled Medicaid populations; and decrease the threshold for deducting medical expenses to 5.8 percent of income (from the 10 percent threshold established by the ACA). evening, the
States choosing a block-grant arrangement would have to cover only the mandatory populations of children and pregnant women. They would not have to follow current law with respect to benefits, except that they would have to provide "hospital care; surgical care and treatment; medical care and treatment; obstetrical and prenatal care and treatment; prescribed drugs, medicines, and prosthetic devices; other medical supplies and services; and health care for children under 18 years of age." These terms are not defined, but it seems fairly clear that the bill eliminates the requirement that children are entitled to Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services. Moreover, states choosing the block grant would no longer have to accept willing providers (i.e., they could decide not to cover specialists, or even pediatricians), and would no longer have to provide services on a statewide basis. States would have to opt for the block grant in 10-year increments. Because of the great flexibility states would have, and the way federal funding would flow to states over the years, it may be tempting for states to take up this option.
Some of the managers' amendments are intended to placate the far right end of the spectrum, while others are intended to placate the more moderate Republicans. It is not clear that they will address the concerns of the Senators on each end of the Republican spectrum in that body.
The Congressional Budget Office is expected to issue new cost and coverage estimates for the amended bill prior to the House vote, which could influence the outcome of the vote.
More Information Related to Health Care Reform
In anticipation of new health care proposals, a number of organizations released resources about current insurance coverage for children, families and people with disabilities; how Medicaid restructuring and other anticipated changes might affect states, families, and health care providers; and how to evaluate proposals for change.
- Restructuring Medicaid in the American Health Care Act: Five Key Considerations (Kaiser Family Foundation)
- State Fact Sheets on Impacts of Block Grants or Per Capita Caps on Long-Term Services and Supports (AARP Public Policy Institute, but the fact sheets relate to LTSS for all populations)
- Little-Noticed Medicaid Changes in House Plan Would Worsen Coverage for Children, Seniors, and People with Disabilities and Increase Uncompensated Care (Center on Budget and Policy Priorities)
- State Snapshots of Children's Health Coverage (Georgetown Center for Children and Families and the American Academy of Pediatrics)
- 2017 State Medicaid Fact Sheets (Children's Hospital Association and the American Academy of Pediatrics; data about the importance of the Medicaid program to children, pediatricians and children's hospitals)
- Multiple fact sheets on kids and Medicaid, including EPSDT (Georgetown Center for Children and Families)
- Evaluating Medicaid Block Grant & Per Capita Cap Proposals (National Health Law Program)
- Data Points to Consider When Assessing Proposals to Cap Federal Medicaid Funding: A Toolkit for States (Robert Wood Johnson Foundation State Health Reform Assistance Network)