Republicans forge ahead with ACA change efforts

The House Republican Study Commission today posted a draft of an Affordable Care Act replacement bill: the American Health Care Reform Act of 2017.

The Affordable Care Act has two parts: the Patient Protection and Affordable Care Act of 2010, and the health care parts of the Health Care and Education Reconciliation Act of 2010.

The Republican Study Commission draft bill calls for the “repeal of Obamacare,” including all of PPACA and all of the health-care related provisions in HCERA.

The AHCRA bill would create an inflation-adjusted, above-the-line “standard deduction for health insurance,” with the starting value set at $7,500 for individuals and $20,500 for families. The SDHI tax breakwould apply to all income and payroll taxes.

The bill also would:

- - - Let people use the money in a health savings account to pay for high-deductible major medical insurance.
    - Let health insurers sell coverage across state lines.
    - Create new provisions protecting doctors against medical malpractice suits, such as a mandatory independent medical review panel before the discovery process begins; and
    - Provide $25 billion in funding over 10 years for state high-risk pools for people with serious health problems.

During the period from 2011 through 2013, a temporary ACA risk pool program went through about $5 billion in three years, and ran out of funding a year earlier than expected.

“Premiums in these state high-risk pools will be capped at 200 percent of the average premium in the state,” according to a bill summary.

The Health Insurance Portability and Accountability Act of 1996 gives people with health problems guaranteed access to health coverage if they maintain continuous coverage, but HIPAA does not put any limits on the rates health insurers can charge sicker people for coverage.

The AHCRA bill would let consumers use more types of coverage to maintain continuous coverage. In the past, for example, workers had to exhaust high-cost COBRA group health coverage continuation benefits to qualify for access to protection from the HIPAA access guarantee, according to a bill summary.

The AHCRA bill would let sick group health plan enrollees show they had maintained continuous coverage and buy health coverage using the HIPAA access guarantee without exhausting COBRA benefits, according to the bill summary.

Meanwhile, in the Senate, members voted 51 to 48 to begin debate on Senate Concurrent Resolution 3. The measure orders congressional committees to begin work on an effort to de-fund the ACA. Under Senate budget resolution rules, the committees could meet budget targets by changing or killing federal laws and programs, such as the ACA.

One Republican no vote

Most pieces of legislation need a two-thirds majority to get to the Senate floor.

A budget resolution, and another type of budget measure, a budget reconciliation resolution, can get through the Senate with a simple majority vote.

Supporters of Senate Concurrent Resolution 3 had barely enough votes today to get the resolution to the Senate floor.

All Democrats and independents in the Senate who voted opposed letting the resolution come up for debate.

One Republican, Sen. Rand Paul of Kentucky, voted against the measure.

Paul said on the floor that he opposes the measure because he believes it will lead to Republicans voting for a budget that will add $9.7 trillion in new debt to the federal budget deficit over 10 years.

“Is that what we really campaigned on?” Rand asked. “That our first order of business will be [passing] a budget that never balances?”