In March, House Republicans announced a set of updates to the American Health Care Act (AHCA). The proposal would replace the Affordable Care Act and includes provisions that could affect how Americans access and pay for health care. While the AHCA is not law, several proposed changes are important to understand because they may affect coverage, costs, and state Medicaid programs.
Summary of proposed changes
-
Makes insurance more affordable
Premiums were projected to change under the AHCA proposals. The updates include limits on deductibles and out-of-pocket maximums and the removal of annual and lifetime limits on essential health benefits. These actions are intended to affect affordability for individuals.
-
Increases insurance accessibility
Several potential updates were intended to improve insurance accessibility. These include guaranteed issue regardless of pre-existing conditions, advanceable tax credits for low- and middle-income individuals and families, increased tax credits for older adults approaching retirement, financial assistance for people with high health costs, and a reduction in the allowable tax deduction threshold for medical expenses.
-
Removes the individual insurance mandate
The proposal would remove the federal individual mandate that required most people to purchase insurance, and it would repeal the related penalty. It also proposed refunds for people who had paid the penalty under prior rules.
-
Removes the employer mandate
The updates would remove the federal requirement that many employers provide insurance coverage for full-time employees. Employers would still be able to manage contributions to health FSAs and HSAs within current regulatory limits.
-
Promotes state flexibility for Medicaid
The proposal established a Patient and State Stability Fund intended to give states more options to customize Medicaid programs. States could opt for a block grant instead of a per capita allotment baseline, create optional work requirements for certain adults, and reevaluate program choices periodically.
-
Freezes Medicaid expansion for new states
New states would not be allowed to adopt the Medicaid expansion under the proposal, while existing enrollees could be treated under transitional rules. Enrollment would continue to be reviewed based on income and eligibility changes.
-
Increases reimbursement for some Medicaid enrollees
Provisions included annual adjustments for certain elderly and disabled Medicaid enrollees to account for inflation and help maintain access to care for vulnerable populations.
Health care providers and organizations reviewing how proposed changes could affect operations may want to review coverage options such as Medical Care Providers Insurance.
Home care agencies and those that handle patient funds or third-party interactions may consider protections like a Home Health Care Third-Party Fidelity Bond to address specific risks.
Community programs or events that use temporary structures should also review general liability and specialty coverages such as Tent Erection Insurance.
If you want to express your views to elected officials, contact your U.S. representative or senator. If you need help reviewing options, you can ask an agent to review your situation and available policies.
Frequently Asked Questions
How would removing the individual mandate affect insurance premiums?
Removing the mandate could change who enrolls in coverage, which may affect premium levels; the exact impact depends on enrollment and regulatory details.
Can states choose their own Medicaid rules under the proposal?
The proposal sought to give states more flexibility, including options like block grants or per capita allotments and the ability to add certain eligibility requirements.
Will employer-sponsored coverage change automatically?
Changes to employer requirements would depend on federal law and employer decisions; employers may still adjust plan offerings within regulatory limits.
What should a small health care business consider right now?
Businesses should review their insurance needs, operational risks, and available specialty coverages, and consult an insurance professional for tailored guidance.