Understand how we got here — and how to move forward.


April 21, 2017

AHCA is back—and the White House wants a vote next week

Daily Briefing

House Republican leaders are working on a new deal that leaders hope could revive the American Health Care Act (AHCA), and the White House is pushing for a vote next week.

The White House began playing a larger role in negotiations on a bill to repeal and replace the Affordable Care Act (ACA) shortly after the House Speaker Paul Ryan (R-Wis.) pulled the AHCA from the consideration on the House floor. The White House has been working with Rep. Mark Meadows (R-N.C.), chair of the conservative House Freedom Caucus, and Rep. Tom MacArthur (R-N.J.), co-chair of the moderate Tuesday Group, to strike a deal that addresses each group's concerns.

The latest deal

Details of the potential deal have not been publicly released, but a draft amendment dated April 13, obtained by Politico, shows it would allow states to apply for "limited waivers" to opt out of the ACA's so-called Essential Health Benefits requirements for insurers and certain community rating requirements.

According to the draft amendment text, community rating rules that affect how much insurers can charge based on enrollees' age and gender would not be waivable. However, the draft text would allow states to waive community ratings regarding health status if states establish a high-risk pool or participate in a federal high-risk pool.

Further, while states under the amendment could not waive the age requirements, the AHCA overall would allow insurers to charge older enrollees up to five times as much as younger enrollees—up from a three-to-one ratio permitted under the ACA.

Coming for a vote?

Some senior Trump administration officials suggested the House could vote Thursday on the revised bill, but GOP lawmakers appear less convinced, Politico reports.

A senior GOP aide said, "The question is whether it can get 216 votes in the House, and the answer isn't clear at this time," adding, "There is no legislative text and therefore no agreement to do a whip count on."

S&P: ACA's exchanges are not in a 'death spiral' 

President Trump in a news conference on Thursday also suggested a final bill could take longer to pass. He said, "I'd like to say next week, but I believe we will get it, whether it's next week or shortly thereafter."

According to Politico, sources familiar with the deal say it could deliver between 15 and 20 votes from House Freedom Caucus members who previously were going to vote no. Some moderates, however, oppose the new deal and say that MacArthur has not coordinated with other Tuesday Group members on his discussions. For instance, Rep. Dan Donovan (R-N.Y.) said, "The amendment doesn't address the things that I had concerns about—the things I think are detrimental to the people I represent."

Next steps

Under the White House's timeline, Congress would reconvene on Tuesday after a two-week recess, leaving them just one day to whip votes on the AHCA while also tackling a fiscal 2017 spending bill to keep the government running beyond Friday.

Politico reports that House Republicans are expected to discuss the latest changes during a scheduled conference call Saturday (Bade et al., Politico, 4/20; Scott, Vox, 4/20; Cunningham et al., "PowerPost," Washington Post, 4/20; House/Jacobs, Bloomberg, 4/20; Radnofsky et al., Wall Street Journal, 4/20; MacArthur amendment text, 4/13).

What does health care reform beyond the ACA look like? Join us on May 2nd

Stuart Clark, Managing Director

The first part of the Health Care Advisory Board’s latest “State of the Union” explores what the Trump administration and GOP-controlled Congress will mean for the future of coverage expansion, payment reform, and federal entitlement programs.

The presentation provides an objective analysis of the next era of health care reform, unpacking the potential futures of Medicare, Medicaid, and the private insurance market—and what those changes would mean for provider strategy. The presentation also includes a detailed assessment of the accomplishments, shortcomings, and unintended consequences of the Obama-era reforms.

Register for the webconference

Have a Question?


Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.