5 Things Healthcare Payers Need to Know about the House-Passed American Health Care Act (AHCA)

On May 4th, the House GOP passed the American Health Care Act (AHCA),which reverses and replaces parts of the Affordable Care Act (ACA).

Zelis’ Vice President of Legislative Affairs, Matthew Albright has reviewed AHCA and identifies five things healthcare payers should know about the passed version of the Act.

The Bill as passed:

  1. Leaves many elements of ACA untouched, including the EFT mandate and provisions and subsequent regulations on network adequacy and access.
  2. Replaces individual mandate with a 30% percent surcharge intended to encourage people to maintain their insurance coverage;
  3. Eliminates a number of taxes on high income earners and insurers, and medical device manufacturers;
  4. Cuts federal funding for Medicaid by 25% over 10 years and allows choice of per-capita caps or block grants to states;
  5. Allows states to apply for “default approvals” of waivers of ACA rules on pre-existing conditions, essential health benefits, and the cost of insurance based on age. AHCA also provides $8 billion over five years to help people in state-run high-risk pools cover premium spikes.

According to Albright, the Bill has a very long road ahead of it.  “Few industry groups are pleased with the bill in its current form,” says Albright, “For instance, AHIP believes the bill needs ‘important improvements’ and many expect the bill to undergo significant changes as it goes through the Senate.”

Zelis will continue monitor the Bill’s progress as the Senate reviews ACHA and keep our clients informed when major developments occur.