Amendments to the AHCA: Can Republicans draw enough support?

In what can be seen as a normal step in the legislative process, Republicans released a set of amendments to their proposed American Health Care Act (AHCA) last night. Many believe that these and possibly other amendments to the current bill will be necessary to draw enough Republican support to advance the bill through a House vote, which is set to take place this Thursday.

The reconciliation process involves many technical rules and hurdles that the Republicans must navigate. Amendments to the bill came in the form of policy changes and technical changes, but don’t necessarily address major concerns stemming from the Congressional Budget Office’s (CBO) analysis. The CBO report indicated that though the overall bill would save money over the next 10 years, it would cause an increase in premiums in the short term and leave an additional 24 million Americans uninsured by 2026. 

Let’s take a look at the proposed changes.

On the policy side


  • Terminates Obamacare’s mandatory requirement for states to expand Medicaid for certain childless non-disabled, non-elderly, non-pregnant adults up to 133 percent of the Federal Poverty Level (FPL)
  • Creates a ‘grandfathered’ status for certain Medicaid enrollees who will continue to receive advanced federal funding if they remain eligible in 2020
  • Offers states the option to elect block grant funding for Medicaid or receive a per capita allotment, with several reporting requirements for states that choose this option
  • Allows states to require able-bodied Medicaid enrollees to work in order to remain enrolled
  • Doesn’t offer enhanced federal funding to states that choose to expand Medicaid now or in the future

Cadillac Plan Tax

  • Grants an additional year of relief, delaying implementation until 2026 rather than 2025

Other tax provisions

Accelerates repeal of the following tax provisions; repeal becomes effective in 2017:

  • Medical Device Tax
  • Tanning Tax
  • Additional tax on distributions from a Health Savings Account (HSA) for non-qualified medical expenses
  • Medicare Tax Increase

On the technical side

  • Technical changes (fewer in number than policy changes) mostly involve alterations and corrections to the language used in the bill. For instance, the proposed amendment removes a policy to allow excess tax credit funds to be deposited into an otherwise eligible individual’s HSA; It also removes the section of the bill related to tax credits to allow for technical restructuring of that piece of the law by the Senate.

Overall, the number of amendments introduced by Republicans is limited. Key changes to the provisions of the bill are centered on Medicaid. Republicans are attempting a tight rope walk, balancing the interests of conservative party members that want an immediate rollback of Medicaid against the interests of party members from states where Medicaid expansion was adopted. 

The other major change, which will not be truly defined until—and if—the bill passes the House and makes it to the Senate, is related to the advanceable, refundable tax credits. Based on the CBO report, these credits, along with other factors such as a change to underwriting ratios, will likely cause a steep increase in premiums for older Americans. In order to quell concern, these credits will be “restructured” by the Senate. Also, it means that the bill doesn’t have to be scored again by the CBO. 

Can Republicans now garner the support required to pass the bill at the House level? We’ll see. Republican leadership, along with the White House, will likely do all they can over the next few days to whip up support to assure the bill moves forward, but additional amendments are not likely before Thursday’s vote.