House Positioning on H.R. 1628, the ‘American Health Care Act’


As you are aware from the major news outlets, after a substantial ‘run-up’ and negotiations, the House leadership cancelled votes that had been slated for both Thursday and Friday on the House legislation to repeal and replace the Affordable Care Act (ACA), entitled H.R. 1628, the “American Health Care Act” (AHCA). What will this mean, at least in the short term, for O&P patients and providers?

While not in the original bill, one turn in the negotiations was announced as an amendment to the bill so that H.R. 1628 would have resulted in repeal of the ACA’s “essential health benefits.” There is a general consensus that this action would have posed potentially significant challenges for some, perhaps many of our patients and would likely have been detrimental for O&P. The assurance that “habilitative and rehabilitative services” (it was one of the ten categories is the ACA that every federally-approved health plan was required to include) must be included in health plans would have been eliminated.

This action, coupled with the bill’s plan to change the federal Medicaid matching funds provided to the states could have been expected to prompt a renewal of more state efforts to slice Medicaid, similar to AZ a few years back dictating ‘no microprocessors, and no orthotic coverage for anyone over 18.’ When Medicaid was enacted decades ago, the law did not articulate an explicit assurance of an O&P benefit for these patients… the ACA’s ‘essential health benefits’ did serve as a fairly explicit assurance for O&P care, which largely blocked such state Medicaid O&P cutback efforts.

Another component of the House repeal and replace plan was authorization for the sale of health insurance policies across state lines, a step that concerned many in the patient community. It would have resulted in requiring ‘falling back’ largely on what protections are offered via state-by-state parity law protections. The much-discussed selling of insurance across state lines would also have an important impact, as it would create a ‘least common denominator’ effect. Hypothetically, if CA has a strong parity law with patient protections, and UT does not, when that UT carrier sells a policy in CA, it will not have to measure up to the stricter CA parity provisions.

With no vote having occurred on H.R. 1628, there is at present not a bill on any fast track in either House or Senate to repeal and/or replace the Affordable Care Act, so in the short term, the status quo prevails, albeit with limitations as to the number of options enjoyed on the insurance exchanges by patients in many areas of the country, and other shortcomings of the ACA. Obviously, this is a complicated picture, with lots of uncertainties as to if and when other legislative initiatives may move on this. AOPA will continue to keep you informed of significant developments. Those who tracked the House proceedings, and who have attended recent AOPA Policy Fora saw a couple of familiar faces often referenced in the H.R. 1628 deliberations. Both Rep. Mark Meadow (R-NC) the Chair of the House Freedom Caucus, and Rep. Charlie Dent (R-PA) have spoken at the AOPA Policy Forum in recent years. Both were interviewed frequently, and their views often mentioned in accounts of the House process and proceedings. Dont be left out – come to the AOPA Policy Forum, in Washington, May 24-25. Become an insider on what is happening in health care, and assure that your voice is heard! Learn more about the Policy Forum.