House Republican leaders have changed their healthcare reform bill to please both conservative and moderate members of their party.
The so-called manager's amendments to the American Health Care Act, most of which were backed by Republicans on the House Budget Committee last week, would:
1. End most of the ACA's taxes at the end of this year, one year earlier than in the original bill.
2. Bar any new states from expanding Medicaid to low-income adults and receiving enhanced federal funding for that population.
3. Establish a work requirement for Medicaid enrollee adults who aren't disabled, elderly or pregnant. States that institute a work requirement would receive a 5% administrative bonus.
4. Give states the option of getting Medicaid funding in the form of fixed block grants not tied to the number of enrollees or federal funding in per-capita allocations.
5. Increase the growth rate of capped federal payments to the states for elderly and disabled beneficiaries by the medical component of the consumer price index plus one percentage point; the growth rate for other beneficiary groups would be the medical component of CPI, which lags behind actual per-capita Medicaid spending by 0.7 percentage points, according to the Congressional Budget Office.
6. Delay implementation of the ACA's excise tax on high-value employer health plans for an additional year, from 2025 to 2026.
7. Penalize New York state for requiring some counties to contribute to Medicaid funding. Upstate Republicans pressed for this provision—already dubbed the “Buffalo buyout”—to reduce property taxes in their counties, but providers warned it would lead to big Medicaid spending cuts that would hurt services.
The fate of the bill remains shaky in the Senate, where a number of Republicans have voiced strong concerns about its $880 billion in Medicaid spending cuts over 10 years and the projected increase in uninsured Americans by 24 million.