No (CBO) Score, No Problem: House Passes ACA Repeal-and-Replace Bill

May 5, 2017
President Trump’s campaign pledge to dismantle the Affordable Care Act (ACA) passed its first hurdle Thursday afternoon, as the House of Representatives passed a revised version of the American Health Care Act (AHCA) that would repeal and replace parts of the ACA. Passed by a slim 217-213 margin, the AHCA now heads to the Senate, where it faces an uncertain future. All House Democrats and 20 Republicans voted against the bill.

As Health Policy Weekly readers know, the original AHCA was withdrawn from consideration last month because it lacked the necessary votes for passage. Since then, 2 compromises garnered sufficient Republican votes from the moderate Tuesday Group and the conservative and libertarian Freedom Caucus:
  • MacArthur Amendment. An amendment offered by Rep. Tom MacArthur (R-NJ), co-chair of the Tuesday Group, helped win support from the Freedom Caucus. The amendment allows states to waive certain insurance rules and consumer protections required under the ACA, particularly those related to essential health benefits and community rating.
  • Upton Amendment. Rep. Fred Upton (R-MI) added an amendment that secured sufficient moderate Republicans by adding $8 billion over 5 years for individuals with preexisting conditions in states that make that request.
The revised legislation was brought to the floor even though it has not yet been scored by the non-partisan Congressional Budget Office (CBO). This is significant because this means that the legislation was voted on without knowing its estimated cost and what the impact will be on the number of insured individuals. The CBO did score the AHCA in its original form and estimated it would cause 24 million people to lose health insurance within a decade. The American Hospital Association has said it is unlikely the MacArthur amendment would improve the coverage estimates.

A timeline for consideration by the Senate is undetermined. If the upper chamber does take up the AHCA, makes changes, and passes a revised version, the standard process would be for a House-Senate conference committee to iron out differences. The Senate, with little room for defection from ACA repeal-replace legislation, has already indicated it will start over and likely will not use the House bill as the basis for its work. What this all boils down to is that healthcare reform is still under discussion and will be for a long time. The Senate, unlike the House, is not known for speed but rather deliberation. HPW staff thanks the Senate in advance for providing weeks of material to come.

Health Policy Weekly is written by Xcenda, a consultancy and business unit of AmerisourceBergen Specialty Group. Visit Xcenda’s online archive to access more health policy news.

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