New Proposals Leaked in ACA Repeal Draft

Yesterday, as we wrote about Trump’s and Republican’s Affordable Care Act (ACA) proposals, a bizarre game of hide and seek took place at the Capitol. Congressmen, both left and right, and the media all frantically scurried about the buildings, seeking a hidden draft bill that contained new changes to the draft leaked last week. Today, Politico reported documents detailing the new draft were obtained. The changes, which are dated February 24, 2017, are sure to go through another round before the draft’s final release.

Last week’s bill introduced the following proposals:

  • New age-rated tax credits
  • A 30% premium penalty on non-continuous coverage
  • Move to a 5-to-1 age-band rating
  • Protection of grandfathered and grandmothered plans
  • Grants states authority to determine Essential Health Benefits (EHBs)
  • Move to per capita spending for Medicaid
  • Repeal of mandate penalties and ACA taxes
  • Introduces a tax on employer-based health plans over a 90% premium standard

The changes reported today are fairly minor and will likely do little to appease the outcry from both the super conservatives and liberals alike. According to Politico, the latest draft makes the following changes to the draft released last week:

  • Eliminates the “grandmothered” provision, a proposal which would have allowed health plans pre-ACA that do not conform to its requirements to remain in the insurance market indefinitely. Protection for these plans was previously set to end at the end of this year.
  • Sets forth the proposal to create some sort of cut-off for high earners for the tax credit. The tax credit would still remain age banded, and not income banded, but would phase out for an income level that has yet to be determined.
  • Makes a change to the “state innovation grants” by creating a reinsurance fund which would reimburse insurers for beneficiaries with high claims between $50,000 and $350,000. This is an interesting addition given the current conservative stance that such payments constitute bailouts and the current battle over risk corridor payments.

Given the details we have, the new changes don’t seem significant. The same major principles that were previously contained in policy agendas such as “Better Way” and Tom Price’s “Empowering Patients Act” continue to make up the framework of the draft. The most notable provisions are versions of Health Savings Accounts (HSAs), interstate insurance, the use of high-risk pools, Medicaid payment reform, and the use of tax credits. In a new memo, our Policy Team examines these Republican healthcare proposals, their components, and their limitations.



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