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The House voted 217-213 on May 4 to pass the American Health Care Act (AHCA), which would repeal and replace portions of the Affordable Care Act (ACA). The bill will now move to the Senate for consideration.

House Republicans received enough support from their own caucus to pass the legislation with new amendments that included:

• Allowing states to apply for waivers from critical consumer protections provided in the ACA, including age rating, requirements that health insurers must cover certain essential health benefits, and the ban on health status underwriting.
• Providing more financial assistance—$8 billion over five years—to help cover premium spikes for individuals with pre-existing conditions in states that do not require health plans to cover essential health benefits
• Requiring states to determine essential health benefits beginning in 2018, for purposes of the premium tax credit
• Adding additional $15 billion to the State Stability Fund for maternity and newborn care as well as mental health and substance abuse services
• Delaying a repeal of a Medicare tax increase

These amendments to the original bill have not been scored by the nonpartisan Congressional Budget Office (CBO). The CBO projected in March that AHCA would result in 14 million more people being uninsured in 2018 than under current law for a projected total of 24 million uninsured by 2026. It projected the plan would slash the federal deficit by $150 billion between 2017 and 2026. It is likely that these CBO predictions will change with the additional amendments.

The legislation is opposed by the vast majority of the medical community including the American Medical Association, American College of Physicians, American Hospital Association, Federation of American Hospitals, AARP and patient advocacy organizations.

The CAP's positon is to not support the AHCA legislation in its current form. The bill does not address the majority of the CAP's overarching principles for health care reform. The bill also would leave intact ACA provisions that have been harmful to pathologists. Fundamentally, the bill does not address regulatory burdens on physicians nor does it detail how it would pay for tax repeals. The CAP's policy principle framework for changes to the ACA is:

• Ensuring that individuals can access affordable insurance without interruption and take steps toward coverage for all Americans
• Maintain key insurance reforms (eg, pre-existing conditions)
• Protect prevention and screening services
• Stabilize and strengthen the individual insurance market
• Reduce regulatory burdens on physicians

More updates on the legislation the will be published in future editions STATLINE.