Ken Calvert

American Health Care Act

Why We Need the American Health Care Act

With premiums rising, deductibles increasing, and health care choices decreasing, American families know all too well that Obamacare is collapsing. That’s exactly why I promised the voters in my district that I would take action and work to repeal and replace Obamacare with patient-centered health care solutions that actually reduce costs and expand choices. The simple fact is our health care system is on life support and whoever won last year’s election was going to need to resuscitate it.

The American Health Care Act is an important step towards the fulfillment of that promise. The bill empowers families and doctors with health care decisions, rather than giving Washington bureaucrats the power to impose one-size-fits-all regulations. Not everyone requires the same type of health plan, so the bill gives Americans more affordable options and the ability to find the right plan for them.

Pre-existing Conditions and Dependents
It’s important to note that the House plan will continue to protect American families by ensuring people with pre-existing conditions are not denied heath care policies and allowing the coverage of dependents until they are 26 years old.  (You can read more about the pre-existing conditions provisions HERE.)

Medicaid
Obamacare’s Medicaid expansion prioritized able-bodied adults above those the Medicaid program was originally designed to help – the most vulnerable Americans.  We will not pull the rug out from anyone as we work to give states the flexibility they need to take care of those most in need. The American Health Care Act responsibly freezes enrollment to allow natural turnover in the Medicaid program as beneficiaries see their life circumstances change. Our approach is both fiscally responsible and fair, ending the Obamacare expansion that unfairly prioritizes able-bodied working adults over the most vulnerable.

Mental Health and Addiction
The American Health Care Act also includes $15 billion specifically for mental health and substance abuse disorders. Last Congress, I cosponsored and supported the passage of the bipartisan 21st Century Cures Act. This new and innovative law includes a comprehensive mental health package that is the result of years of conversations with patients fighting mental health conditions, battling substance use disorders, and families supporting their loved ones who just need a little help to get through this difficult – and often very emotional – situation. 
I also supported the Comprehensive Addition and Recovery Act (P.L. 114-198) which expands access to addiction treatment services as well as medications that reverse overdoses. Furthermore, it encompasses prevention programs through recovery treatments to best help those struggling with addiction. 

Repealing Costly Taxes
The American Health Care Act will also help patients by repealing Obamacare taxes on prescription drugs, over-the-counter medications, health-insurance premiums and medical devices.


Repealing and replacing Obamacare is not an easy task, but the American people don’t want to hear excuses – they want health care policies that actually work. I look forward to working with my colleagues throughout the legislative process to send a bill to President Trump’s desk that saves our health care system.



Amendment Update:

Two significant amendments to the American Health Care Act have been added in recent weeks.

MacArthur Amendment: An amendment provided by Rep. Tom MacArthur gives states flexibility in addressing premiums and best serving their populations. The amendment gives states an option to tailor coverage limitations, however in order to do so they must follow a strict process. Specifically states must explain how a waiver will reach the goals of lowering premiums, increasing enrollment, stabilizing the market/premiums, and/or increasing choice. Read the text of the MacArthur amendment HERE

Some important points about the MacArthur Amendment:

  • States may only apply for a waiver if they have their own risk pool in place and the coverage of people with pre-existing conditions will be protected.
  • The amendment only applies to the individual insurance market. Americans with employer-provided coverage or government coverage (Medicare, Medicaid, Tricare, VA benefits, etc.) would not be affected.
  • These higher premiums could only be charged for a period of one year to an individual who did not maintain continuous coverage. After an individual has maintained continuous coverage for twelve months they would then return to standard rates.
  • Under the Upton amendment (see below), $8 billion would be set aside to help lower premiums and other out-of-pocket costs for patients in the individual market with pre-existing conditions who do not maintain continuous coverage and live in states that request and receive a waiver.

NOTE: There is no indication that California would seek a waiver. Therefore, in our state there would be no changes to the coverage of essential health benefits dictated under federal law. Every health care plan would cover benefits such as prescription drug coverage, pregnancy and childbirth, and mental health services.


Upton Amendment
: An amendment by Rep. Fred Upton provides an additional protection for people with pre-existing conditions in states that seek a waiver. Specifically, the amendment provides an additional $8 billion for states seeking a waiver. These resources will allow people with pre-existing conditions who haven’t maintained continuous coverage to acquire affordable care. The AHCA provides significant protections for people with pre-existing conditions, but these additional resources help ensure affordable coverage for individuals in states that have received a waiver. The money will be provided to the State and Patient Protection fund. Read the text of the Upton amendmentHERE.

Questions and Answers

Q: Does the American Health Care Act protect Americans with pre-existing conditions?

 

A: Yes. The AHCA as amended by the MacArthur amendment explicitly maintains protections for pre-existing conditions. Guaranteed issue of coverage, guaranteed renewability of coverage, and the prohibition on insurance companies denying coverage due to pre-existing conditions are all maintained. The AHCA as amended specifically clarifies that its provisions cannot be construed as allowing insurers to limit coverage for those with pre-existing conditions. All of these protections will remain the law.

 

 

Q: Will the American Health Care Act as amended allow those with pre-existing conditions to be priced out of the market, effectively rendering those protections useless?

 

A: The AHCA does allow states to seek a limited waiver to give them the option to allow insurance companies to charge a person with a health condition higher premiums for one year ONLY if they (1) discontinue their health coverage and (2) choose not to obtain new health coverage within 63 days. This means that the protections against being charged higher premiums for a health condition are preserved for every individual market plan holder who maintains continuous coverage. These protections would also be in place for new enrollees, so long as they maintain continuous coverage going forward. Furthermore, a state can only obtain a waiver for the federal regulations on community rating if it establishes a "high-risk pool" or participates in an "invisible high-risk pool" program (these programs help cover the costs of covering expensive patients). So, people with health conditions who do not maintain continuous coverage and are therefore charged higher premium rates will always have access to affordable health coverage.

 

 

Q: In many cases high-risk pools haven’t worked in the past. Are they really a solution to address pre-existing conditions in states that apply for a waiver?

 

A: Before Obamacare, many states used high-risk pools to help individuals with pre-existing conditions. While some state pools worked and were well-funded, other states did not focus resources on the program and achieved mixed results. Under AHCA, states would have access to a new Patient and State Stability Fund to help finance risk-sharing programs like high-risk pools, as well as a new Federal Invisible Risk-Sharing program. All told, $130 billion dollars would be made available to states to finance innovative programs to address their unique patient populations. This new stability fund ensures these programs have the necessary funding to protect patients while also giving states the ability to design insurance markets that will lower costs and increase choice. In contrast, Obamacare provided $5 billion from 2010-2014 for high-risk pools.

 

 

Q: Why does the American Health Care Act allow insurers to charge Americans higher premiums on the individual market if they fail to maintain continuous health care coverage?

 

A: The government should not require Americans to purchase health insurance. However, Americans should recognize the importance of maintaining health insurance and find a plan that meets their health care needs, regardless if they have access to an employer or government-provided plan or need to purchase a plan on the individual market. The continuous care provisions in the AHCA are intended in incentive Americans to purchase health insurance and not simply wait until they have a serious illness to obtain coverage.


Q: Are Members of Congress and congressional staff exempt from the AHCA?

A: No.  Just as Members of Congress and congressional staff are not exempt from Obamacare and currently receive their health insurance coverage through the D.C. Exchange, Members unanimously (429 to 0) voted to approve H.R. 2192 to ensure that should the AHCA pass, Members and staff would be required to adhere to the requirements under the AHCA.  



Read the text of the American Health Care Act HERE