Per capita cap for Medicaid programs, health care paper help

Summary of the American Health Care Act
This summary describes key provisions of H.R. 1628, the American Health Care Act, as approved by the House
of Representatives on May 4, 2017, as a plan to repeal and replace the Affordable Care Act (ACA) through the
Fiscal Year 2017 budget reconciliation process.
American Health Care Act
H.R. 1628
Date plan
March 6, 2017; passed by the House of Representatives on May 4, 2017
 Repeal ACA mandates (2016), standards for health plan actuarial values (2020),
and, premium and cost sharing subsidies (2020).
 Modify ACA premium tax credits for 2018-2019 to increase amount for younger
adults and reduce for older adults; allow tax credits to apply to coverage sold outside
of exchanges and to catastrophic policies. In 2020, replace ACA income-based tax
credits with flat tax credits adjusted for age. Eligibility for new tax credits phases out
at income levels between $75,000 and $115,000
 Retain private market rules, including requirement to guarantee issue coverage,
prohibition on pre-existing condition exclusions, requirement to extend dependent
coverage to age 26. Modify age rating limit to permit variation of 5:1, unless states
adopt different ratios, effective 2018. Retain essential health benefits requirement,
with state option to waive. Retain prohibition on health status rating with state
option to waive for individual market applicants who have not maintained continuous
 Retain health insurance marketplaces, annual Open Enrollment periods (OE), and
special enrollment periods (SEPs).
 Impose late enrollment penalty for people who don’t stay continuously covered.
 Establish Patient and State Stability Fund with federal funding of $115 billion over
9 years available to all states, and additional funding of $8 billion over 5 years for
states that elect community rating waivers. States may use funds to provide financial
help to high-risk individuals, promote access to preventive services, provide cost
sharing subsidies, and for other purposes. In 2020, $15 billion of funds shall be used
only for services related to maternity coverage and newborn care, and mental health
and substance use disorders. [For 2018-2026, a further $15 billion is allocated
through the fund for Federal Invisible Risk Sharing Program (reinsurance). This
program is established as part of the fund, though administered by CMS to make
payments directly to health insurers.] In states that don’t successfully apply for
grants, funds will be used for reinsurance program.
 Repeal funding for Prevention and Public Health Fund at the end of Fiscal Year
2018 and rescind any unobligated funds remaining at the end of FY 2018. Provide
supplemental funding for community health centers of $422 million for FY 2017
 Encourage use of Health Savings Accounts by increasing annual tax free
contribution limit and through other changes
 Limit enhanced FMAP for Medicaid expansion to states that adopted the
expansion as of March 1, 2017, and sunset enhanced FMAP for those states as of
January 1, 2020 except for beneficiaries enrolled as of December 31, 2019 who
do not have a break in eligibility of more than 1 month.

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