Timothy Jost explains the GOP repeal and replace legislation

Examining The House Republican ACA Repeal And Replace Legislation

By Timothy Jost
Health Affairs Blog, March 7, 2017

On March 6, 2017, the House Republican leadership introduced Affordable Care Act repeal and replacement budget reconciliation bills in the Ways and Means (W&M) and Energy and Commerce (E&C) committees. The bills, collectively titled the American Health Care Act, are the committees’ responses to the instructions they received in the Budget Resolution passed by both houses of Congress in mid-January to prepare budget reconciliation legislation to repeal the ACA.

The committees will begin markup of the bills on March 8, 2017.

If the bills are passed by the committees they will be combined by the House Budget Committee and sent to the House Rules Committee, and then to the full House for a vote. The Congressional Budget Office has not released cost estimates of the legislation and it appears that committee markups will proceed without out CBO reports.

Summing Up

In summary, the legislation’s tax cuts will be very attractive to wealthy Americans and health insurers and providers, who would get a trillion dollars in tax breaks. It could cause consternation for Medicaid recipients and state Medicaid programs, which would see federal funding for Medicaid steadily diminish, potentially thinning out coverage. The legislation could be bad news for recipients of current tax credits who are older, sicker, and poorer, and who live in areas where care is expensive. They may be able to afford low actuarial value coverage with the tax credits the bills would provide them, but they are unlikely then to be able to afford the cost sharing that coverage will impose.

Higher-income younger people, on the other hand, would find coverage much more affordable than it is now under the legislation—the tax credits might fully cover their premiums and leave extra for their health savings accounts. Some insurers could find the state reinsurance money and continuous coverage requirement enough of an incentive to stay in the market, but others may not

Finally, one cannot know without a CBO report how this all works out.  But it is hard to see how the bills pay for themselves, and they could result in significant losses in coverage.

Ways and Means summary of their portion of the “American Health Care Act”:

Ways and Means proposed legislation:

Energy and Commerce summary of their portion of the “American Health Care Act”:

Energy and Commerce proposed legislation:


G.O.P. Repeal Bill Would Cut Funding for Poor and Taxes on Rich

By Margot Sanger-Katz
The New York Times, March 6, 2017

Legislative language for what House leaders call the American Health Care Act, released Monday evening, would substantially cut back funding to states that cover poor adults through their Medicaid program. It would cut back on financial assistance for relatively low-income insurance shoppers above the poverty line.

It would offer new financial benefits for the upper-middle class and the rich. Americans higher up the income scale would be eligible for subsidies to help them buy health insurance. Taxes on high incomes would be reversed. And the law would allow people to save more money each year in tax-free health savings and flexible spending accounts — accounts that are most valuable to people who pay high income tax rates and have money to save.


NYT Reader Comments:

By Don McCanne, M.D.
San Juan Capistrano, CA

That's enough. Single payer.