Republicans are making another attempt at a plan to repeal and replace the Affordable Care Act (ACA).
The compromise is known as the MacArthur Amendment to the American Health Care Act (AHCA), and is sponsored by Rep. Tom MacArthur, R-N.J. The proposal would permit states to get waivers eliminating the community rating provision that prevents insurers from charging higher premiums to people with pre-existing conditions.
But in order to waive the community rating provision, states would be required to participate in a federal high-risk pool or establish their own high-risk pool. States would not be able to waive community rating rules based on gender or age, except for reductions of the 5:1 age ratio.
States also would be able to seek limited waivers for requiring health plans to cover essential health benefits.
In order to obtain the limited waiver, states must prove that the purpose of requesting the waiver is to reduce premium costs, increase the number of persons with health coverage, or advance another benefit such as guaranteeing coverage for persons with pre-existing medical conditions.
Requests would be made to the secretary of Health and Human Services, who would decide on approving the request within 90 days of filing the application.
The MacArthur amendment would reinstate the current essential health benefits as the federal standard, except for those states in which a waiver is approved. Those benefits had been removed from the AHCA.
The amendment also would keep many of the provisions of the AHCA, which was withdrawn just prior to coming before the House of Representatives for a vote in March.
Among the provisions that would be kept under MacArthur’s proposal,
- Prohibition on denying coverage for those with pre-existing medical conditions.
- Prohibition on discrimination based on gender.
- Guaranteed issue of coverage to all applicants.
- Coverage of dependents on parents’ plan up to age 26.
- Guaranteed renewability of coverage.
The amendment comes on the heels of reports that another attempt to repeal and replace the ACA would be made prior to President Donald Trump’s hitting the key milestone of 100 days in office late next week.
But further complicating the matter is that Congress must also pass a bill to fund the federal government before parts of it shut down on April 28.
Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected].
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