5 things to know about Republicans’ amended ACA replacement plan

Republicans leaders in Congress have reportedly agreed on a new version of their Affordable Care Act (ACA) repeal-and-replace plan, allowing states to opt out of ACA requirements like essential health benefits and a ban on rating customers on the individual market.

As obtained by POLITICO, the bill being discussed is an amended version of the American Health Care Act (AHCA), the legislation which was pulled hours before a scheduled vote because it didn’t have enough Republican support to pass, with Democrats united against it.

Here are five important things to know about the amended bill:

1. Waiving community rating

Among the ACA provisions states could try to waive is the community rating. Before the ACA, insurers could rate customers on the individual market one-by-one, charging them more based on their age, medical history and health behaviors, like if they smoke. The ACA ended most of these practices, capping the age rating at three-to-one ratio while using a “community rating,” setting premium prices for an entire community rather than individual customers.

2. High-risk pools and reinsurance

Waiving the community rating provision is contingent on a state participates in the AHCA’s Patient and State Stability Fund, a pool of funding to set up high-risk pools or reinsurance program to shore up insurer losses from cover older, sicker enrollees. HHS Secretary Tom Price, MD, has already encouraged states to submit waivers for similar programs.

3. Waiving essential benefits

The amendments also change how the bill handles the ACA’s 10 “essential health benefits” that insurance plans have to offer. These services include: outpatient care, emergency services, hospitalization, maternity care, mental health, prescription drugs, rehabilitation, laboratory services, preventive care and pediatric services.

Rather than eliminate the required benefits entirely, the bill allows states to waive the requirements through applications to HHS.

4. How HHS would approve those waivers

For all these waivers, states would have to demonstrate in their applications that eliminating these regulations would have the effect of “reducing average premiums for health insurance coverage in the state.” They likely would, as plans would become less expensive if sicker people could be charged more and coverage became skimpier.

What wouldn’t be required, however, is any action from HHS. Rather than require approval from the agency, the amended bill states the waiver will be automatically approved if HHS takes no action on the application within 60 days.

5. Moderates are very skeptical

The conservative House Freedom Caucus is getting much of what it wants in the amended bill, with several members who were previously “no” votes on the AHCA saying they’ll support it with the waiver options.

“A lot of people like it,” said Rep. Dave Brat, R-Virginia, according to the Washington Post.

The changes may lose moderates as it gains conservatives, however, potentially leaving Republicans short of the 218 votes they need to push the bill out of the House.

“I ran in support of a plan that lowers premiums, increases access and lowers health care costs across the board,” Rep. Leonard Lance, R-New Jersey said to POLITICO. “Until I see a Congressional Budget Office score that says the revised bill achieves those goals I remain a 'no' vote.”