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house Bill H.R. 1628

Should the Affordable Care Act be Repealed and Replaced With the American Health Care Act?

Argument in favor

Obamacare has failed to fulfill its main promises to the American people — that health insurance would be affordable for all and that consumers would have the choice of keeping their doctor. This bill repeals and replaces Obamacare with a patient-centered system that will create more options for consumers at an affordable price, while assisting those who need help paying for their insurance and cutting taxes that inhibits economic growth and healthcare innovation.

Beth's Opinion
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03/22/2017
DO NOT ACCEPT THIS REPEAL! WE LOVE OUR OBAMACARE JUST THE WAY IT IS!
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Gregory's Opinion
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03/22/2017
As long as I'm not being forced to buy medical insurance any thing is better than the current system.
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Joe 's Opinion
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03/22/2017
Anything is better at this point than socialist Obamacare
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Argument opposed

Obamacare isn’t perfect, but Congress should focus its efforts on fixing its flaws rather than repealing it and replacing it with a solution that undoes the progress it made in expanding access to affordable healthcare. Millions of Americans would lose their health insurance coverage if this bill were to become law, and it’s expected that it would increase the cost premiums between now and 2020. That’s not an acceptable solution for the American people.

Ashleyrdtx's Opinion
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03/21/2017
This is a horrible bill and everyone knows it. Fix the ACA. Phone 👏Calls 👏Matter 👏. Don't be weary! Call your Representatives TODAY! Here is a sample script with talking points ----> https://www.indivisibleguide.com/resources-2/2017/3/12/oppose-the-american-health-care-act-the-proposed-aca-replacement
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Megan's Opinion
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03/21/2017
What America needs is not a rich health insurance sector (which essentially means that people are paying more than they're receiving in benefits). Americans need healthcare, not health insurance. Every single person is going to need medical services, and it's ridiculous to buy insurance "just in case" for something that is inevitable. People's access to healthcare should not be depend on their income. It's a human right, and "market friendly solutions" are not an appropriate way to provide this.
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Karen's Opinion
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03/22/2017
This bill is horrible. People will die. Listen to your people who voted you in. Not a POTUS who's under investigation, and approval ratings are in the trash. You will be voted out if you continue to ignore us. We do have a voice when we vote. #VOTENO
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bill Progress


  • Not enacted
    The President has not signed this bill
  • The senate has not voted
  • The house Passed May 4th, 2017
    Roll Call Vote 217 Yea / 213 Nay
      house Committees
      Committee on the Budget
    IntroducedMarch 20th, 2017

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What is House Bill H.R. 1628?

This bill — the American Health Care Act (AHCA) — would repeal and replace the Affordable Care Act (commonly known as Obamacare) through the reconciliation process. In general, the bill repeals Obamacare’s individual and employer mandates, in addition to taxes on health insurance premiums, medical devices, and over-the-counter drugs. It makes reforms to premium assistance tax credits before repealing and replacing them with refundable tax credits, gives states the ability to take their Medicaid funding in the form of block grants rather than open-ended federal support, and makes health savings accounts more accessible to consumers. It would, however, retain two notable provisions of Obamacare: people with pre-existing conditions would not be excluded from coverage and children up to age 26 could remain covered by their parents' health insurance plans.


Tax Credits

This bill would enact several reforms to premium assistance tax credits, which aim to assist consumers with the cost of health insurance by offering them a tax incentive for purchasing it, over a period of several years before repealing them at the end of 2019. They would then be replaced with refundable tax credits starting in 2020.

Under current law, individuals and households with an income less than 400 percent of the federal poverty level (up to $47,550 for an individual and $97,200 for a family of four) are eligible to receive premium assistance tax credits. The amount that a household receives is determined using the lower of two numbers — the premium for the health plan they enroll in, and the premium for the second lowest cost silver plan in their area reduced by their share of premiums.

Before the premium assistance tax credits are phased out completely, the share of premiums that individuals have to pay would be modified in 2019. The share paid by enrollees would be reduced slightly for those with income less than 133 percent of the federal poverty level (FPL), remain essentially unchanged for consumers between 133 percent and 300 percent of the FPL, and increase slightly for those earning over 300 percent of the FPL (more so for people age 50 and up).

Limitations on the recapture of advance payments of the tax credit (i.e. taking back overpayments to individuals) would be repealed for individuals making less than 400 percent of the federal poverty level. Excessive payments to those individuals would be treated as a tax liability in order for the government to get the money back. Premium assistance tax credits would be made available to individuals covered by catastrophic-only health insurance, as such consumers are prohibited from using the tax credits under current law. Additionally, the premium assistance tax credit wouldn’t be available for consumers insured by health plans that cover abortions that aren’t necessary to save the life of the mother or to end a pregnancy that’s the result of an act of rape or incest.

Starting in 2020, refundable tax credits would be available to consumers and would vary by age. Individuals under age 30 would receive a tax credit of $2,000 per year, for people between 30 and 40 the tax credit would be $2,500; for those between 40 and 50 it’d be $3,000; between 50 and 60 it’d be $3,500; and those over 60 who aren’t eligible for Medicare would get a credit of $4,000. The tax credit could be paid monthly directly to the insurer to reduce the recipient’s premium, or individuals can pay their total health insurance premiums without advance payments and then claim the credit at the end of the tax year.

Small business tax credits for buying their employees health insurance would also be repealed effective January 1, 2020 and in the meantime the tax credits would be disallowed for health insurance plans that cover abortions that aren’t necessary to save the life of the mother or to end a pregnancy that’s the result of an act of rape or incest.

Federal funding channeled to states through the bill’s State Stability Funds would be available to use to provide maternity and newborn care. It also clarifies that mental health and substance abuse funds would include inpatient and outpatient treatment for addiction and mental illness, and early intervention for children and young adults with serious mental illness. An additional $15 billion would be solely focused on meeting those needs.

States would be required to determine the "essential health benefits" that insurance plans need to cover to be eligible for enrollees to receive premium tax credits beginning in 2018. 


Taxes

The tax penalty imposed by Obamacare’s individual mandate to buy health insurance would be lowered to zero, meaning that the individual mandate would be repealed immediately and apply for all months after January 2016. The tax penalty imposed the employer mandate for businesses with more than 50 employees to buy health insurance for workers would also be repealed in the same manner with the same effective date. Additionally, the so-called “Cadillac Tax” on high-cost, employer-sponsored health plans would be delayed during the 2020-2025 period before taking effect in 2026 (it’s currently delayed until 2020).

A tax imposed on purchases of over-the-counter drugs using funds from a health savings account (HSA) or Archer medical savings account (MSA) without a doctor’s prescription would be repealed effective in 2017. A scheduled tax increase of 20 percent on distributions from HSAs and MSAs would be reduced to 10 percent for HSA distributions and 15 percent for MSA distributions beginning in 2017. The $2,600 limit on pretax contributions to health flexible spending arrangements (health FSAs) would be repealed for tax years starting in 2018.

The 2.3 percent excise tax on medical devices would only apply to sales that occurred before January 1, 2016 and would be repealed starting with 2017. The additional Medicare tax of 0.9 percent on taxpayers earning more than $125,000 as individuals or $250,000 for couples filing a joint return (which is in addition to the 2.9 percent Medicare payroll tax) would be repealed starting with the 2023 tax year.

A tax on prescription medications imposed by Obamacare would also be repealed effective in 2017. The annual fee on health insurance providers that is passed onto consumers in the form of higher premiums for all calendar years from 2017 onward. An annual fee on branded pharmaceutical manufacturers and importers would also be repealed starting with 2017. A tax on indoor tanning services would also be repealed, effective as of June 30, 2017.

The net investment income tax that applies to individuals, estates, and trusts with income over various thresholds and subjects them to a 3.8 percent tax would be repealed effective in 2017. Under current law the tax applies to income over $250,000 for the surviving spouse of a couple that filed jointly, $125,000 for a married individual filing separately, and $200,000 in any other case.

The $500,000 limit on the amount of compensation that a covered health insurer can deduct as expenses would be eliminated, so they would effectively be treated the same as other businesses in terms of deducting their spending on employee health insurance as compensation beginning in 2018.


Health Savings Accounts

The limit on annual HSA contributions would be increased to equal the maximum annual deductible and out-of-pocket expenses permitted under a high deductible health plan, which are $6,550 for an individual and $13,100 for family coverage effective starting in 2018. Contribution limits would continue to increase by $1,000 for an eligible individual who has turned 55 as is permitted under current law. Both spouses would be allowed to make “catch-up” contributions to the same HSA if they’ve turned 55 before the end of a tax year and use the $1,000 contribution limit increase.

If an individual establishes an HSA within 60 days of enrolling in a high deductible health plan, it would be treated as if the HSA was established on the date the person’s coverage under the plan begins. This would have the effect of allowing those individuals to exclude money they spend from the HSA on healthcare during that period from their taxable income beginning in 2018.


Medicaid

This bill would give states the option of receiving a flexible block grant of funding for adults and children enrolled in Medicaid starting with fiscal year 2020 instead of federal assistance being tied directly to state spending. Funding for the block grant would be determined based on a fixed amount of money for each adult and child enrolled in the “base year” and growth rates for future years would be pre-set (funding for elderly and disabled enrollees would remain based on enrollment). This means that states would receive a fixed amount from the federal government of funding each year, rather than federal support matching state spending on Medicaid (federal dollars covered anywhere from 50.7 to 79.6 percent of a state’s Medicaid program in 2015). States that choose block grants would receive funding in that way for a period of 10 years.

States would be given the ability to institute a work requirement for non-disabled, non-elderly, non-pregnant adults as a condition for receiving coverage under Medicaid starting on October 1, 2017. Subsidized and unsubsidized employment, on-the-job training, work experience, job search and readiness programs, vocational training, community service, and study towards a general equivalence certificate would satisfy the work requirement. States that implement the work requirement would receive a 5 percent administrative boost to their federal assistance.

The requirement for states to expand their Medicaid program for certain childless, non-disabled, non-elderly adults up to 133 percent of the FPL would repealed, and the option for states to cover adults above that level would end on December 31, 2017.

States would retain the ability to cover enrollees in their state’s Medicaid expansion at the state’s regular federal assistance level. Expansion participants who enroll before the end of 2019 would be given “grandfathered” status, and states would receive the enhanced matching rate under current law for those enrollees as long as they’re eligible and enrolled in the program. Starting in 2020, states wouldn’t be able to expand Medicaid.

To prevent the state of New York from passing on Medicaid costs to the state’s counties, the federal government would be prohibited from reimbursing New York state’s Medicaid funds that were raised by local governments.


Amendments

Two notable amendments have been added to this legislation. 

  • The MacArthur Amendment would allow states to obtain waivers from requirements of the Affordable Care Act. That'd include the requirement for health insurers to cover "essential health benefits" which include things like maternity care or mental health services, age band ratings that prevent the elderly from paying more than five times what the young pay in premiums.  In their application, states would have to show that the waiver will do at least one of the following: reduce premiums, increase enrollment, stabilize the market, stabilize premiums for individuals with pre-existing conditions, or increase choice in the market. If a person fails to maintain continuous coverage, this amendment would allow them to be charged more when they seek insurance based on their health status.
  • The Palmer-Schweikert Amendment would create a $15 billion risk sharing program to help states offset potential premium increases in the individual market. 
  • The Upton-Long Amendment would provide an additional $8 billion from 2018 to 2023 to states that have been granted a waiver under the MacArthur Amendment in order to help people with pre-existing conditions who haven't maintained continuous health insurance coverage.

Impact

Americans who have or want to obtain health insurance; businesses; providers of healthcare and health insurance; state governments, particularly agencies that administer their state’s Medicaid program; and federal agencies, especially HHS and the IRS.

Cost of House Bill H.R. 1628

The CBO estimated (prior to the changes made by the Rules Committee’s manager’s amendment) that this bill would reduce federal deficits by $337 billion over the 2017-2026 period, or about $33.7 billion per year. Spending would be reduced by $1.2 trillion, while revenue to the government would fall by $883 billion through the repeal of taxes and fees.

More Information

In-Depth: Sponsoring Rep. Diane Black (R-TN) praised this bill’s passage out of the House Budget Committee — which she chairs — as being a key step in the process of repealing and replacing Obamacare:

“Our role in this process is to combine the work of the authorizing committees and report the full bill to the House and we have dutifully completed that responsibility. There is always debate and disagreement during the legislative process but I firmly believe that the result is a better piece of legislation. Obamacare is collapsing and we made a promise to the American people that we would save them from this disastrous law. We have now taken yet another step toward our goal of bringing out patient-centered, free-market reforms to the American people.”

House Speaker Paul Ryan (R-WI) reminded his fellow Republicans in a presentation that they “fought the creation of [Obamacare] and accurately predicted it would not work, ran for office in 2010, in 2012, in 2014 and in 2016 on a promise that if given the chance we would repeal and replace this law.” He also emphasized that this bill is part of a three-pronged approach that includes administrative action and additional legislation, and that the AHCA “is the closest we will ever get to repealing and replacing Obamacare. The time is here. The time is now.”

This bill has encountered a significant amount of opposition from across the political spectrum, including some Republicans and conservative groups who believe it doesn’t go far enough in repealing Obamacare.

Congressional Democrats in particular, though, have vehemently objected to the bill and its attempt to undo much of former President Obama’s signature domestic policy accomplishment. In the Budget Committee’s bill report, they offered the following dissent:

“This is not a health care bill at all. It is instead a classic expression of conservative ideology, taken to its illogical extreme. It provides a huge gift of $600 billion in tax cuts that mostly benefit billionaires, millionaires, and corporations, paid for by taking critical health coverage and benefits away from millions of middle-class families, vulnerable children and families trying to escape poverty, seniors, women, people in rural communities, and people with serious health problems or disabilities. This is Robin Hood in reverse, but far worse.”

As part of the reconciliation process (which allows a budget bill to pass the Senate with a simple majority rather than 60 votes), both the House Ways & Means and the Energy & Commerce committees approved this legislation, before handing it off to the Budget Committee. The Budget Committee then passed it on a 19-17 vote that aside from two GOP dissenters — Reps. Mark Sanford (R-SC) and Dave Brat (R-VA) — was decided along party lines.


Media:

Summary by Eric Revell

(Photo Credit: Vice President Pence Twitter / Public Domain)

AKA

American Health Care Act of 2017

Official Title

To provide for reconciliation pursuant to title II of the concurrent resolution on the budget for fiscal year 2017.

    DO NOT ACCEPT THIS REPEAL! WE LOVE OUR OBAMACARE JUST THE WAY IT IS!
    Like (224)
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    This is a horrible bill and everyone knows it. Fix the ACA. Phone 👏Calls 👏Matter 👏. Don't be weary! Call your Representatives TODAY! Here is a sample script with talking points ----> https://www.indivisibleguide.com/resources-2/2017/3/12/oppose-the-american-health-care-act-the-proposed-aca-replacement
    Like (1428)
    Follow
    Share
    What America needs is not a rich health insurance sector (which essentially means that people are paying more than they're receiving in benefits). Americans need healthcare, not health insurance. Every single person is going to need medical services, and it's ridiculous to buy insurance "just in case" for something that is inevitable. People's access to healthcare should not be depend on their income. It's a human right, and "market friendly solutions" are not an appropriate way to provide this.
    Like (1072)
    Follow
    Share
    This bill is horrible. People will die. Listen to your people who voted you in. Not a POTUS who's under investigation, and approval ratings are in the trash. You will be voted out if you continue to ignore us. We do have a voice when we vote. #VOTENO
    Like (700)
    Follow
    Share
    This proposed bill is a laughable disgrace. Millions of people will suffer if this is allowed to pass. Women, low income families, anyone with a pre-existing condition, those who need mental healthcare, and not to mention those who work in healthcare and will lose their jobs, will suffer because of this bill.
    Like (658)
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    Health care should be a right for everybody, not a privilege for the wealthy.
    Like (513)
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    We should be making life easier for our citizens. Taking away benefits is criminal. We will not forget who votes for this.
    Like (384)
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    Keep ACA. Reject Wealthcare.
    Like (336)
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    This is a travesty. Any representative who votes in favor of this 'repeal and replace' mockery will surely lose the respect of their constituents and their seat in the future.
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    UPDATE to original comment below: Vote NO on this bill! Please remember that the Republican Congress and President ‘45’ is more interested in cost cutting for the federal government rather than providing AFFORDABLE HEALTH CARE for ALL AMERICANS! If this were not true, Washington would be actively, and publicly, pursuing measures that would CONTROL costs in the medical industry AND require health care insurance providers to provide FULL coverage for BASIC HUMAN NEED, My humble opinion is that a single service provider e.g., the Medicare and VA system would be the best option. There are certainly issues with these systems, such as absolute unintelligible bureaucracy that seriously bogs down the efficiency and increases overall costs to the system, but this can be addressed and upgraded. The best element, and least liked by our beloved free market capitalists is the fact that costs can be controlled AND LIMITED. We MUST realize that the medical industry should not be in the business to make profit over human care. But that is where we are, and we MUST be strong enough to admit this. All I hear is “it’s too expensive”! Ask yourself WHY? Do your research and review the salaries of those in the industry (Hospitals, Pharmaceutical companies, Health Insurance providers, companies that develop and sell medical technology and equipment to hospitals/doctors). Bottom line, people are making a “killing” off FELLOW AMERICANS that are in desperate need of medical services. This is not a moral approach, rather it’s a cold, bottom line first business (profit) approach. Please vote NO on this bill, THEN REALLY FIX THIS MESS! ORIGINAL COMMENT: We must amend the ACA that was pioneered by President Obama to be MORE inclusive, and expand its authority to establish pricing controls on services and pharmaceuticals. Our biggest problem is based on the fact that the health care industry operates first on profit and expansion, not on the welfare of Americans. Profit first, people second. How can we allow that to be. What value to our health comes from pharmaceutical commercials? What value to our health comes from hospital expansion, mergers, closures? You may argue efficiency, but all I see is absurdly posh buildings and grounds, high end hotels to accommodate ultra wealthy patients from overseas, high end architectural buildings with ornate art called hospitals. It's all about the money that ultimately drives up the cost to the patient. We need to amend the Affordable Care Act in a way that it can provide affordable health care to every American by controlling the cost to operate.
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    You can't ACCESS healthcare if you can't AFFORD healthcare. We can't play politics with real people's lives.
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    The ACA is why I live in rural Montana and work for a small business. Without it I would be working in Oregon for a larger company that can afford to offer full benefits. Trumpcare only benefits his billionaire buddies. It is not an improvement if less people are covered.
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    If this dog of a bill goes through then every voter should work tirelessly to repeal and replace those responsible for its passage. Passing a bill when the ramifications are unknown is poor governance at best and borders on malfeasance. Everyone in their life will need health care. Rich and poor. This is not about insurance. It's about our moral responsibility as citizens of a great nation.
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    The whole premise of this new replacement seems to me........I can't afford a Maserati, but the government is now "allowing" me the opportunity to buy one by offering the choice. The whole idea is ridiculous! I certainly hope the Trump supporters are happy with their choice, because they've damned the rest of us to hell!!
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    It should be repaired and and adjusted. No need to repeal it completely.
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    I continue to be amazed at how morally and intellectually bankrupt lawmakers have become. The year is 2017 and instead of marching forward towards a universal healthcare solution, like the majority of the industrialized world, we continue to slide ever more into the abyss. Whatever happened to…“The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped.” – Hubert H. Humphrey
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    The American Healthcare Act is not a viable replacement for ACA. Energy should be focused on improving existing policies of ACA and not proposing legislature that would eventually deprive over 20 million citizens of their healthcare.
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    As long as I'm not being forced to buy medical insurance any thing is better than the current system.
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    I cannot accept that our country, so blessed with wealth and innovation cannot afford to provide at least a minimum level of healthcare for ALL of its citizens. We certainly find ourselves able to pay for many other things.
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    The ACA may be imperfect, but this bill is a travesty which gives tax breaks to the wealthy while gutting Medicaid and causing millions to lose health coverage.
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