Health insurance is always a hot topic of discussion in American politics and society, and recently the subject of that discussion has centered around the introduction of the American Health Care Act of 2017 (AHCA). The AHCA is a bill proposed by President Trump and Congressional Republicans that would replace the current health care guidelines set in place by the Affordable Care Act (ACA) put into law by President Obama in 2010. Ever since President Trump first announced that his platform included repealing Obamacare, many have wondered what that would entail and what the specifics of how a replacement health care plan would look. Now that Congress has revealed the AHCA to the public we get a chance to see just exactly what the health care future that President Trump has envisioned will look like.
Just as the ACA became synonymous with Obamacare, the AHCA is commonly known as Trumpcare or Ryancare – after Representative Paul Ryan, who played a significant part in the formation of the bill. After months of creating and revising, the first version of Trumpcare was presented first released to the public on March 6th, 2017 giving the American Citizens to the answers to their questions about what President Trump’s health care promises would mean for them.
There were a few unexpected ways in which the proposed AHCA was initially similar to the ACA and left in place some of the changes that Obamacare brought to the country. The factor that was to remain the same was the treatment of pre-existing conditions. Before the ACA, insurance companies were both allowed to deny coverage and charge an increased rate to those with pre-existing conditions. Once President Obama enacted the ACA, insurance companies were permitted to do neither, and the AHCA supported leaving those protections for those affected by pre-existing conditions.
Another similarity was that both bills did not allow insurance providers to put annual or lifetime caps on the amount of insurance that was paid out for one individual.
One of the major proponents of the AHCA, unsurprisingly, was the repeal of the ACA. President Trump, Congressional Republicans, and others have long been critics of what they believed was a failed attempt to bring affordable insurance to the country. While a few of the aspects of ACA introduced are also present in the AHCA, Trumpcare would eliminate Obamacare itself.
Chief among the tenets of Obamacare that Trumpcare proposed changing was the insurance mandate. Under the ACA, the government penalizes individuals if they do not purchase health insurance with the logic that if everyone purchases insurance, the premium of those who are healthy will even out the cost of those who are sick. The AHCA eliminates the mandate but does allow for insurance companies to charge a higher premium to those with a lapse of insurance coverage of more than 63 days as an incentive for citizens to keep continuous coverage.
Another change from Obamacare that the AHCA proposes is the elimination of income-based subsidies and tax credits for expenses out of pocket. Instead, the new bill proposed tax credits for premiums allocated by one’s age. With the elimination of the credits and subsidies is the abolition of the taxes that are currently used to help fund them. All four taxes that are currently funding the Obamacare credits would disappear under Trumpcare.
One change that could potentially affect elders the most is that the AHCA would allow insurance companies to charge them up to five times as much as their younger counterparts, whereas currently the ACA only allows insurers to charge up to three times as much.
After the initial introduction of the AHCA, there were those who were unhappy with the bill on both sides. Some believed that Obamacare was superior to Trumpcare while others felt that it did not do enough to remove what they felt were the harmful changes the ACA introduced.
The MacArthur Amendment
The response to the inconclusive feedback on the AHCA was to take the bill even further away from Obamacare to compromise between the centrist and conservatives of the Republican Party in the Republican-controlled Congress. Congress made new changes to the act in the form of the MacArthur amendment, named after Representative Tom MacArthur (R – NJ) who worked with other Representatives to come to propose changes that both tenets of the Republican Party would find satisfactory. The house finished the new version of the AHCA on April 20th, 2017.
Although the original version of Trumpcare provided the same protection as Obamacare, the MacArthur amendment proposes allowing states to apply for waivers to some of the conditions regarding pre-existing conditions if they set up a high-risk pool. In the case that the person has insurance in a state that does have a high-risk pool and they allow their insurance to lapse, insurance companies would be allowed to charge them more if they have a pre-existing condition under the new version of the AHCA.
Annual and Lifetime Limits
Straying from the precedents set by the ACA and the first edition of the AHCA, the MacArthur amendment would allow for insurance companies to place an annual and lifetime limits to coverage for an individual.
Age Difference Premium
The proposed changes to the AHCA would not just allow insurance companies to charge those older more than those who are younger. Just like with pre-existing conditions, states would be able to apply for a waiver to excuse them from this condition if they have a high-risk pool under the revised Trumpcare proposal.
Touching a topic that neither Obamacare nor the originally proposed Trumpcare bill touched, the MacArthur amendment would see all federal payments to Planned Parenthood stopped for a one-year period.
The Future of the AHCA
The American Health Care Act passed the House of Representatives on May 24th, 2017 winning by a hair by a vote of 217 to 213. The next step on this bill’s journey to become law will be the Senate, where it only needs to win by a majority vote since it is considered part of the federal budget. However, we will likely see more changes ahead to the bill ahead before it ever reaches President Trump as the Senate is not enthusiastic to pass the bill as is. Even Republican Senators Rob Portman and Ted Cruz have stated that the Senate will have to make changes to the bill as well before it sees a vote.