House Republicans unveil ACA repeal, replacement bill

House Republicans on the evening of March 6 unveiled their much anticipated Patient Protection and Affordable Care Act (ACA) repeal and replacement legislation. A markup of The American Health Care Act is scheduled in the Ways and Means Committee for Wednesday, March 8. “It is going to be a big week” , House Speaker Paul Ryan’s, R-Wis., press secretary AshLee Strong said on March 6.

The ACA repeal and replacement legislation will repeal most of the ACA-related taxes, as well as eliminate the individual and employer mandate penalties. It will, however, retain the controversial Cadillac Tax, though delaying it until 2025. Additionally, the measure would provide a monthly tax credit between $2,000 and $4,000 a year (per individual and capped at $14,000 per family) to assist certain individuals to purchase coverage.

“This is a plan we are all working on together – the House, Senate, White House – so there aren’t rival plans here. We are all working on this together with the administration,” Ryan said on March 6 before release of the bill. Senate Finance Committee ranking member Ron Wyden, D-Ore., however, criticized the legislation minutes after it was released, saying, “We will fight this.”

Four Senate Republicans sent a March 6 letter to Senate Majority Leader Mitch McConnell, R-Ky., saying they would not support an ACA replacement bill that did not offer key protections for Medicaid expansions. The senators, including Sens. Rob Portman, R-Ohio and Shelley Moore Capito, R-W.V., wrote that while they support efforts to repeal and replace the ACA, they would not support a bill that mirrored the leaked draft healthcare bill. The potential loss of at least two of these four Republican votes could prevent an ACA repeal and replacement bill’s passage, pulling from the requisite 51 votes in the Senate.

Specific provisions. House Republicans, in a summary released with the bill, explained that the bill would:

• Dismantle ACA taxes, including taxes on prescription drugs, over-the-counter medications, health-insurance premiums, and medical devices.
• Eliminate the individual and employer mandate penalties.
• Prohibit health insurers from denying coverage or charging more for pre-existing conditions. Allow dependents to continue staying on their parents’ plan until they are 26.
• Establish a Patient and State Stability Fund.
• Revise Medicaid by transitioning to a “per capita allotment.”
• Enhance and expand Health Savings Accounts (HSAs).
• Provide a monthly tax credit, between $2,000 and $14,000 a year, for low- and middle-income individuals and families not insured through work or a government program.
Repeal of tanning tax. The bill would repeal the 10 percent sales tax on indoor tanning services, starting in 2018.

Remuneration from certain insurers. The bill would repeal the $500,000 limit on the deduction of a covered health insurance provider for compensation attributable to services performed by an applicable individual starting in 2018.

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