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    Four reasons GOP ACA replacement failed without a vote


    Reason #3: Premium changes would vary significantly by age.

    Under the proposed legislation, insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law, substantially reducing premiums for young adults and substantially raising premiums for older people, the CBO stated.

    Fenton says the goal of this change clearly was to attract younger (and generally healthier) individuals into the risk pool with lower premiums, but the additional flexibility in age rating was a key sticking point for the AARP and other powerful interest groups that opposed the legislation.

    Adds Tacchino, “Not only would the legislation have changed the underwriting ratios, but the credits that would be available to Americans would be administered in a way that older citizens would now have much higher premiums. Oftentimes older Americans have a much higher need for healthcare coverage.”

    Reason #4: The bill significantly curtailed federal support for Medicaid.

    In particular, it allows states to require able-bodied adults to work and would phase out Medicaid expansion. After 2020, states that expanded Medicaid would no longer receive enhanced federal funding to cover low-income adults like they did under the ACA and states that haven't expanded would be immediately barred from doing so.

    “These proposed Medicaid changes were some of the most controversial provisions of the AHCA,” Fenton says. “The ability for states to impose work requirements was added to the legislation shortly before the scheduled vote on the House floor, in an effort to attract more conservative House Republicans. But this provision, along with phasing out the Medicaid expansion in general, might have made the bill less attractive for a number of more moderate Republicans, particularly in the 31 states that already expanded Medicaid.”

    Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.


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