House Republican leaders posted a new packet of American Health Care Act bill materials on their website late Wednesday, and they say they could bring AHCA up for a new vote on the House floor by the end of the week.

House members could consider the same version of AHCA, H.R. 1628, that came close to getting a floor vote in March, along with two major proposed amendments.

(Read Stalled Health Bill Wins New Support From Conservative Holdouts on ThinkAdvisor.)

The underlying AHCA bill would make many changes to Affordable Care Act funding and spending provisions. To strongly discourage people from waiting until they get sick to pay for coverage, the bill would create a new late-enrollment penalty for health coverage buyers who fail to keep major medical coverage in place after they become adults.

One of the amendments heading toward the House floor is the widely discussed ACA rule waiver amendment proposed by Rep. Tom MacArthur, R-N.J.

The proposed MacArthur amendment would let a state bring back some medical underwriting if the state set up a special insurance program, or “high-risk pool,” for people with health problems, or if the state agreed to participate in a new federal “invisible risk pool” program, according to the amendment text included in the packet. The invisible risk pool program would be somewhat like a new version of the temporary ACA reinsurance program, which expired at the end of 2016.

Summaries of the proposed MacArthur amendment released in the past week have not been clear about how the medical underwriting provision would work. The amendment would let states allow medical underwriting only for health coverage buyers who had failed to keep health coverage in place.

In a state with a risk pool that received a MacArthur amendment ACA rule waiver, a health insurer could ask a consumer to pay more for coverage if the consumer had not kept health coverage in place. The insurer could not deny the consumer access to coverage.

A state with a MacArthur ACA rule waiver could also adopt its own version of the ACA essential health benefits package, or standard benefits package.

The MacArthur amendment does not appear to set any minimum federal standards for the MacArthur-waiver state risk pools, the MacArthur-waiver invisible risk pool program or the MacArthur-waiver state essential health benefits packages.

Rep. Gary Palmer, R-Ala. (Photo: Congress.gov)

Rep. Gary Palmer, R-Ala. (Photo: Congress.gov)

A second AHCA bill amendment heading for a House floor vote would establish a Federal Invisible Risk Sharing Program for issuers of individual major medical coverage.

That amendment, introduced by Rep. Gary Palmer, R-Ala., and Rep. David Schweikert, R-Ariz., would provide $15 billion in funding from 2018 through 2026, according to the amendment text included in the packet. The program manager would use that cash and assessments on health insurance issuers to run what appears to resemble a reinsurance program. The program would reimburse issuers for a portion of the cost of covering individual major medical policy insureds with claims over $1 million.

At press time, the documents were available on the House “Bills This Week” website.

In related news, the Trump administration has told Democrats that the administration will continue to make ACA cost-sharing reduction subsidy program payments.

The cost-sharing reduction subsidy program helps low-income ACA exchange plan buyers with plan deductibles, coinsurance bills and co-payment bills.

Republicans in Congress sued former President Barack Obama’s U.S. Department of Health and Human Services over ACA cost-sharing reduction program payments, arguing that the Obama administration had no valid appropriation from Congress to make the payments.

The House and the Trump administration agreed after the November elections to put the cost-sharing reduction program suit on hold while the Trump administration started efforts to reshape the ACA. The parties are supposed to give a federal appeals an update on the status of the case May 22.

Democrats have worried that the Trump administration might cut off program payments to insurers after the hearing, but the administration reportedly has agreed, during negotiations over a temporary funding bill meant to avert a shutdown of the federal government, to continue to make the payments. 

— Read Health Insurance Bill Dealmaker Draws Fire From Both Sides on ThinkAdvisor.