Health Reform Bill Continues in House; Estimates Suggest Major Increases in Uninsured

The House of Representatives is expected to resume consideration of the American Health Care Act (AHCA) this week following the release of the Congressional Budget Office (CBO) analysis of the legislation which estimates the bill would increase the number of uninsured people by 14 million in 2018 and up to 24 million by 2026.

The AHCA would repeal or replace several provisions of the Affordable Care Act (ACA) – a priority of the new presidential administration and Congress.

Key provisions include:

  • Repeal of the current deduction limit ($500,000) on remuneration from certain health insurance providers
  • Repeal of the ACA annual fee on brand drug manufacturers, importers, and health insurers
  • Repeal and replacement of the ACA’s health-related tax policy. This amendment would, among other changes: modify the premium tax credit, provide for recapture of excess payments of premium tax credits, repeal the ACA Medicare tax increase, and repeal the individual and employer mandates
  • Repeal, starting in 2020, of the cost-sharing subsidy, originally designed to lower out-of-pocket costs for customers purchasing Silver plans through an exchange
  • Establishment of a Patient and State Stability Fund that would devote $100 billion between 2018 and 2026 to all 50 states for the creation of risk pools to subsidize the sickest and costliest patients, as well as to stabilize premiums in individual markets
  • Elimination, starting in FY’19 of the Prevention and Public Health Fund, created under the ACA to “to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public health care cost.”
  • Repeal of Medicaid expansion starting in 2020
  • Increased funding for the Community Health Center fund
  • Reform of Medicaid financing through the creation of a per capita cap model starting in FY’20
  • Elimination of the Disproportionate Share Hospital cuts

“While members of Congress continue to evaluate the AHCA, we ask that they carefully consider its impact on coverage,” said ACC President Richard A. Chazal, MD, FACC. “As reflected in CBO’s analysis of the legislation, the estimated impact of the AHCA does not align with ACC’s Principles for Health Policy Reform. We are concerned over the sharp projected increase in the number of uninsured Americans, especially among our most vulnerable populations.”

The College’s principles prioritize improved coverage for—and access to—efficient, high quality care; protection for individuals with pre-existing conditions; and continued national investment in preventive care, medical research and innovations.

“We believe every member of Congress shares a common goal: to improve our nation’s health care system. To that end, we ask all members of Congress to work together to find pragmatic solutions that maintain patient access to care,” said Chazal. “ACC has a strong foundation of clinical expertise and scientific integrity. We offer ACC’s members and staff as a resource to policymakers on both sides of the aisle as we strive together to improve coverage and access for all of our patients.”


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