It is too soon to predict the fate of the American Health Care Act (AHCA), or, as we call it, TrumpRyanCare. But, the AHCA as currently proposed – and the debate among Republicans over its provisions – represents a significant statement. That statement: the core provisions of the ACA regarding insurance market reforms now appear to be accepted by both Republicans and Democrats. This is significant and may well be considered the “legacy” of Obamacare.
As previously discussed on this site, the ACA sought to provide increased access to health insurance by addressing two different sorts of access: “market” access (“If I apply for a policy, can I get one?”) and “financial” access (“Can I afford a policy?”). If you look at AHCA from this perspective, it is important to note that AHCRA changes some of the market access provisions of ACA – but only around the margins. Overall, most of the core market access provisions of ACA are left without significant changes under AHCA. These include provisions that:
• Prevent plans from determining premiums or denying coverage to those with preexisting conditions;
• Guarantee renewability of coverage;
• Require insurance policies certain minimum types of coverage;
• Cap out-of-pocket costs;
• Allow coverage of dependent children until age 26; and
• Give individuals certain rights in appealing the denial of claims.
The major battles over AHCA (both within the Republican party and between Republicans and Democrats) are over the financial access provisions of ACA and AHCA: the existence and structure of financial subsidies to enable individuals to buy coverage.
The fact that AHCA retains so many of the market access provisions of ACA indicates that, by and large, Republicans have accepted these provisions. Perhaps this acceptance is simply based on political expediency – provisions that do not affect the federal budget could be subject to a filibuster. But, nonetheless, the acceptance is significant. If one had proposed these changes 8 or 10 years ago, it is likely that Republican opposition would have been loud and vehement. As the political battles over subsidies and taxes play out, it seems that these insurance – related rules (or variations on them) are on their way to becoming a part of the landscape. In the future, when the day-to-day battles have faded, this legacy will remain.
Staying on top of rapidly changing developments
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