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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