This afternoon, after weeks of rancor and rumor, the House passed the American Healthcare Act, version 2, by a slim majority of 217-213.  YAWN….
Be ready to get overwhelmed with data and misrepresentations from both the right and the left.

This bill was needed as a first step as health insurance options, especially in the Midwest and South, evaporate. Ground Zero moved to Iowa this week with over 90 counties to have no insurance carriers willing to offer coverage under the rules of ACA in 2018.  We are still very close to a domino effect that could eliminate insurance availability to nearly 1/3 of the country in 2018.

The AHCA version 2 does bring some stability into the insurance market for 2018 and 2019. 

Lets try and review the key points here as it stands with the passed bill:

  • 1.   Tax credits versus subsides
  • 2.   Repeals Limit on FSA contributions.
  • 3.   Reinstates medical expense deduction to 7.5% from 10%.
  • 4.   Repeals Medicare 0.9% Surtax.
  • 5.   Increases HSA limits
  • 6.   Repeal of Health Insurance Tax
  • 7.   Repeals cost-sharing subsidies in 2020 and allows recapture of excess
          subsidy payments.
  • 8.   Eliminates Individual and Employer mandate penalties.
  • 9.   Increases age rating requirement ratio to 5-1 from 3-1. 
  • 10. Allows carriers to surcharge premiums by 30% where there is not continuous
          coverage for 12 months. 
  • 11. Allows States control over age ratio, continuous coverage rateup, and
           Essential health benefits.  
  • 12. Medicaid expansion cut back and rules changes.  Those between 100-138% 
           of Federal Poverty level.
  • 13. Those with more than $500k in home equity on Medicaid, those who need to 
           file proof of income 2x a year. 
  • 14. $100 billion Funds for High Risk Pools

The most likely impact that all Americans will definitely be subject to is “STRESS”.  The Kaiser Foundation today released a report that mentioned 52 Million Americans being subject to a pre-ex clause.  The fine print said “if we returned to medical underwriting that existed in most States prior to ACA”.  The headline stuck 52 million, the details don’t.  

For the next few months, and perhaps longer, most of us, especially those in the industry are going to be spending time reading about fears rather than facts

Indeed, there will be some who will be worse off.   There will be some inconvenienced. Those who buy individual insurance will have to transition to learning a new system.  On the upside, even if this flawed bill is passed as-is, it is likely to encourage more insurers to offer coverage.  This will reduce gross costs and improve access and choices of plans.  For States that opt to drop the essential benefits provision, they will see gross costs drop even more.   

As a well known Congresswoman from California once said ” But we have to pass the [health care] bill so that you can find out what’s in it….” .

We will keep you posted.

Mark Gurda-Editor, Mark is also President of & Castle Group Health, Inc.  Tel: 847-559-8100.

Look to for independent commentary and information about health insurance and reform.