Repeal, Replace, Repair, Rinse and Repeat - Association for Community ...
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Repeal, Replace, Repair, Rinse and Repeat
The ACA/AHCA Rollercoaster and What it Means for New York State
May 9, 2017
Agenda
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The latest from Washington: American Health Care Act (AHCA) Summary and Status Comparison of the AHCA with the Senate Proposal (CassidyCollins) Comparison of AHCA to ACA--and its impact on key healthcare stakeholders and sectors
What's at stake in New York: the current status of the ACA in NYS The future of the Medicaid program
The prospect of a "capped" program The implications for New York and behavioral care
Key elements of AHCA
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Basic construct of legislation is essentially the same as original bill that was not brought to a vote in late March
Repeals Individual and employer mandates
Transforms Medicaid to per capita cap/block grant option
Eliminates enhanced funding for Medicaid expansion
Restructures tax credits for Marketplace/individual market coverage
Eliminates most ACA taxes
State waiver option to opt out of insurance premium rating protections and requirements relating to Essential Health Benefits
$141 billion in new funds between 2018-2026 to stabilize individual and small group market (high risk pools/reinsurance programs), support maternity and newborn care/mental health & SUD services and to help people with pre-existing conditions
Source: New York State of Health, York State Department of Health
Key elements of AHCA
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Latest amendments intended to gain support of Freedom Caucus
Federal Invisible Risk Sharing Program, provides virtual high risk pool that provides $15 billion over nine years to address high cost enrollees' costs
State Waivers would allow states
To replace the Essential Health Benefits with a state-defined benefit package,
To waive the continuous enrollment penalty and
To use health status as a rating factor for up to 12 months for any enrollees who has a gap in coverage
Prohibits premium rating by gender and purportedly precludes allowing insurers to limit health insurers from rejecting applicants based on pre-existing condition--but would still allow insurers to charge higher premiums
Upton amendment provides additional $8 billion (2018-23) to subsidize coverage in states that waive the continuous enrollment penalty and allow premiums to be set based on health status
Source: New York State of Health,
AHCA Implementation Timeline
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2016 2017 2018 2019
2020
2021 2022 2023
Taxes
Retroactive repeal of individual and employer mandates for tax year 2016
Health insurance, Rx, device, net investment income, tanning taxes repealed
ACA tax credits available on and off exchanges (repayment limits eliminated)
ACA premium tax credits and small group tax credits repealed
New refundable tax credits available
Repeal of Additional Medicare Tax
Medicaid
Individual Market
Retroactive repeal of individual and mandate for tax year 2016
Other
Deadline for enhanced federal match for new expansion states (March 1)
Reduced enhanced match for "leader
states"
Per capita cap
construct or optional block grant
begin
Optional work
requirement
permitted
Enhanced federal match
eliminated*
Alternative benefit EHB
standard ends
Nonexpansion
states exempt from ACA DSH cuts
DSH cuts repealed
for all states
Disenrollment of lottery winners permitted
Retroactive coverage
requirement eliminated
Temporary coverage requirements
end;
Elimination of enhanced
match for HCBS
$2 billion annual allotment for nonexpansion states
Increased maximum
HSA contrib-
ution
Penalties for coverage lapses begin (SEPs only)
Penalties for coverage lapses begin (open enrollment)
State option to set EHBs
begins
State option to change age bands
State EHB waivers become available
CSRs phased
out
Permissible
age rating changed to 5:1 or state option
Actuarial value/
metal-level requirements repealed
State innovation grants and invisible risk
sharing program
funds available
2026 2027
Cadillac tax implemented
Note: Unless otherwise noted, dates correspond with effective years (i.e., a tax repealed on December 31, 2019 would be listed under 2020). Some effective dates correspond with fiscal years. *Except for "grandfathered" individuals that are continuously enrolled in the program after December 31, 2019 Uses FY 2016 as base year and trends forward to establish a target spending amount for FY 2019
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