ACA Repeal and Replacement Update – April 6, 2017


Top takeaways from the week: 1) Negotiations on repeal and replace continued this week, as Congress prepares for an upcoming recess back home; 2) The House Rules Committee approved an amendment to the American Health Care Act that would provide $15 billion over the next 8 years for a risk-sharing program; and 3) The White House has indicated that cost-sharing reduction payments to insurers will continue as long as the House v. Price litigation is pending.


This week, Republicans renewed their efforts to find a compromise solution to repeal and replace the ACA. On Sunday, President Trump commented on the ongoing negotiations, tweeting, “Talks on Repealing and Replacing ObamaCare are, and have been, going on, and will continue until such time as a deal is hopefully struck.”

The White House, led by Vice President Pence, convened several meetings between the conservative House Freedom Caucus and the moderate Tuesday Group to gain consensus on potential changes to the American Health Care Act (AHCA) that might help all sides get to “yes.”

House Action –

Vice President Pence met with both the House Freedom Caucus and the Tuesday Group on April 3 and then again the following day. Freedom Caucus Chairman Meadows (R-NC) said afterward that while no agreement had been made, “There was a general agreement that the progress that we’re making is certainly progress, and there are good discussions.” The House Freedom Caucus has continued to call for amendments to the legislation that would eliminate essential health benefits, community rating, and guaranteed issue arguing that the changes would lower premiums; moderates have balked at such proposals given their expected impact on coverage.

As a result of this week’s negotiations, the House Rules Committee met today and passed an amendment to the AHCA by a party-line vote of 9-2. The amendment, proposed by Reps. Palmer (R-AL) and Schweikert (R-AZ) sets aside an additional $15 billion through 2026 for a risk-sharing program to help states lower premiums for health coverage offered in the individual market. Amendment summary:

House Majority Leader McCarthy also sent out an update to House Republicans today describing progress on the ACA repeal bill. The update notes the addition of the Palmer-Schweikert amendment to the AHCA and informs Members that if a deal is reached over the recess, they may need to return to DC for a vote. Update:

Meanwhile, on April 5, the House passed a bill as a part of “phase 3” of the three phases of ACA repeal and replace. Self-insured health plans may purchase stop-loss coverage to cover costs after claims reach a specified level. The Self-Insurance Protection Act (HR 1304) seeks to protect the special coverage by omitting stop-loss insurance from the definition of “health insurance coverage” in the Public Health Service Act, the Internal Revenue Code, and the Employee Retirement Income Security Act (ERISA). The bill passed the House by a vote of 400-16.

Senate Action –

Sen. Paul (R-KY), one of the harshest critics of the AHCA, floated his own AHCA compromise proposal, which would allow the ACA’s subsidies to stay in place, but to reduce them. The compromise is intended to appeal to moderates, as it would help low-income recipients, while also accommodating for conservatives’ concern over entitlement spending.

Senate Democrats sent a number of letters to President Trump and his Administration this week, urging against efforts to dismantle the ACA, requesting information about the Administration’s plans with respect to the pending cost-sharing reduction litigation, and requesting that the Administration release a list originally provided to the House Freedom Caucus of specific ACA regulations the Administration is willing or planning to repeal or dismantle. Letters led by Sens. Baldwin (D-WI) and Casey (D-PA):  and

Administrative Action –

Meanwhile, on Monday, the Administration indicated its intention to continue the ACA’s cost-sharing subsidies while they are part of the ongoing litigation. The statement provides some clarity for insurers as they decide whether to offer plans next year on the exchanges.





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