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House passes American Health Care Act

May 04, 2017 Washington — The U.S. House of Representatives on May 4 voted 217-213 in favor of H.R. 1628, an amended version of the American Health Care Act.

The bill, which next goes to the Senate, is an alternative proposal from Republicans to repeal and replace portions of the Affordable Care Act. After the vote, Bloomberg Government reported that both Sen. Lamar Alexander, R-Tenn., chair of the Senate Health, Education, Labor and Pensions Committee, and Sen. Roy Blunt, R-Mo., chair of the Appropriations Subcommittee on the Departments of Labor, Health and Human Services, Education, and Related Agencies, planned to start with a fresh bill in the Senate. The Congressional Budget Office has not scored the latest version of the bill.

The legislation contains some provisions the ADA supports such as expanding the use of health savings and flexible spending accounts and extending the “Cadillac Tax,” the insurer surcharge on higher cost plans, to an implementation date of 2026, the Association said in a May 3 email to ADA state executives and volunteer leaders.

The bill also contains provisions that cause the ADA concern, chiefly the provision that changes the Medicaid program to a per capita cap allotment system and not offering the use of tax credits for the purchase of stand-alone dental plans.

If the AHCA becomes law, the previous expansion of Medicaid that occurred with the ACA would be rolled back, including lowering Medicaid eligibility for children from 138 percent of the Federal Poverty Level to 100 percent beginning in 2020.

Over the past decade, dental care use among publicly insured children has steadily increased from a 30.6 percent utilization rate in 2000 to a 41percent rate in 2014, according to the ADA Health Policy Institute.

Under the ACA, about 5.4 million adults gained access to dental benefits as a result of the Medicaid expansion. Additionally, dental care use increased between two and five percentage points in the second half of 2014 in Medicaid expansion states with an adult dental benefit.

“The proposal to change Medicaid funding to a per capita allotment would force state programs to make changes that could potentially negatively impact access to and the delivery of dental services in these programs,” the ADA said. “There is no way to predict what impact a financing change such as this would have on the current Early Periodic Screening, Diagnosis and Treatment Program, which includes coverage for dental services.”

The AHCA also contains provisions that allow states to opt for a block grant over a 10-year period for Medicaid, which would impact children and adults who have benefitted from Medicaid expansion. The bill’s proposed Medicaid changes would eliminate over $800 billion in federal spending over 10 years to state programs.

Other ACHA provisions include:

  • Letting states waive the Essential Health Benefits package, including pediatric dental benefits, so that they could specify their own versions of Essential Health Benefit requirements.

  • Allowing states to specify a higher premium payment ratio for older individuals as compared to rates charged younger people. This may impact older individuals’ ability to finance other health services, such as dental care.

  • Allowing people with pre-existing conditions to be charged more for their health plans under some conditions if they failed to maintain continuous coverage. The AHCA’s Patient and State Stability Fund provides $130 billion to states to help offset out-of-pocket costs, stabilize state markets, promote preventive services (such as dental services) and other matters. A Federal Invisible High Risk Pool is authorized as part of the above fund that comes with an appropriations of $15 billion for years 2018 through 2026. The most recent Upton-Long amendment would provide an additional $8 billion over five years to protect people with pre-existing conditions who experienced an increase in premiums.

In anticipation of the possibility of movement on H.R. 1628, ADA staff has been working with a number of Senate offices to ensure the Association’s position on the issues is understood.

Follow all of the ADA advocacy efforts at ADA.org\Advocacy.