The big new House Republican ACA change draft is here

The Affordable Care Act change fight

The draft appears to draw heavily from the Better Way proposal backed by House Speaker Paul Ryan, who is shown above. (Photo: Ryan's office) The draft appears to draw heavily from the Better Way proposal backed by House Speaker Paul Ryan, who is shown above. (Photo: Ryan's office)

House Republicans have brought a major, 123-page Affordable Care Act change bill draft out of its secret chamber.

The version of the draft bill on the web at press time was not searchable, but it appears to be similar to the draft Republican ACA change bill that leaked in mid-February, whch, in turn, was similar the "Better Way" outline that House Speaker Paul Ryan released this past summer.

Related: GOP plan could give states pots of commercial health cash

Republicans hold just 52 seats in the Senate. The new bill draft is designed as a budget measure that can pass through the Senate with just 51 votes, rather than as an ordinary bill that would need 60 votes to reach the Senate floor.

The bill would not actually repeal or replace the ACA, but it would change major ACA insurance risk management and tax credit programs. It would, for example, eliminate the individual health insurance ownership mandate and the employer group health offer mandate. It would shift Medicaid toward a block grant system.

Like the leaked draft, the new draft would start out providing $15 billion in funding to replace the current ACA risk-adjustment and reinsurance programs. In one respect, the new bill would provide richer support for insurers than the ACA: The new version would require that some of the new state grant funding be used to pay for a replacement for the ACA reinsurance program.

The original ACA reinsurance program, which helps reimburse issuers of individual major medical coverage for enrollees with catastrophic claims, was set to expire after 2016.

The new draft would replace the current ACA premium tax credit subsidy program, which provides income-based help with paying for ACA public exchange plan coverage, with an age-based credit that would help people pay for any individual major medical coverage that complies with the ACA, whether that coverage is purchased inside or outside the ACA exchange system.

The recent leaked draft seemed to limit use of the age-based tax credit as an advance tax credit to ACA exchange users. The new version would let other individual health purchasers use the credit to pay for coverage while the coverage year was under way.

The draft does not appear to affect many other ACA programs, such as the summary of benefits and coverage program.

A copy of the bill is available here.

Related:

Walden framework could shape post-ACA health underwriting

Republicans' new ACA replacer, dissected

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