A report released today by the Congressional Research Service compares how the House of Representatives’ H.R. 1628 and the Senate’s Better Care Reconciliation Act of 2017 would repeal or modify provisions of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended). For example, both would substitute the ACA’s premium tax credit for premium tax credits with different eligibility rules and calculation requirements, and both would effectively eliminate the ACA’s individual and employer mandates.
Both the AHCA and the BCRA also would make a number of changes to the Medicaid program. They would repeal some parts of the ACA related to Medicaid, such as the changes the ACA made to presumptive eligibility and the state option to provide Medicaid coverage to non-elderly individuals with income above 133% of the federal poverty level (FPL). They also would amend the enhanced matching rates for the ACA Medicaid expansion and the ACA Medicaid disproportionate share hospital (DSH) allotment reductions. The most significant Medicaid-related new provisions in the AHCA and the BCRA would convert Medicaid financing to a per capita cap model (i.e., per enrollee limits on federal payments to states) starting in FY2020 with a block grant option for states. Both also include a provision that would permit states to require nondisabled, non-elderly, non-pregnant adults to satisfy a work requirement to receive Medicaid coverage.
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