​​​​​​​New bills point to piecemeal ACA replacement approach

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Four draft bills released in the House show that Republicans are embracing a step-by-step approach to replacing the ACA even as it's being repealed.

As Republicans shift toward a piecemeal approach to replacing the Affordable Care Act, four newly introduced bills offer a glimpse of what that strategy may look like.

President Donald Trump has pushed for a quick repeal of the healthcare law, with a near-simultaneous replacement, but the latter is unlikely without cooperation from Democrats. At their retreat last week in Philadelphia, GOP lawmakers expressed concern about the consequences of a speedy ACA repeal, but also appeared to be moving toward replacing the law through a series of smaller bills.

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Four draft bills released in the House show that Republicans are indeed embracing this approach even as they are still working on repealing the law, according to a blog post from Health Affairs. “The proposed legislation is primarily an attempt to calm the jitters of nervous insurers, but it also attempts to respond to complaints that Congress is preparing to abandon consumers with preexisting conditions,” healthcare policy expert Tim Jost writes.

The four bills revealed last last week would kick in for plan year 2018 and seek to accomplish the following:

  • The first bill (PDF) would require the Department of Health and Human Services to first verify an enrollee's eligibility for special enrollment periods before insurers make coverage effective those individuals. Insurers have complained that some consumers are using special enrollment periods to game the system by signing up for coverage only when they are sick.
  • The second bill would alter the ACA's rate-banding rule from 3:1 to 5:1, meaning insurers could charge older, sicker consumers as much as five times more than younger, healthier consumers, rather than just three times as much. Bringing more healthy people into the risk pool can decrease costs as they spread the expenses of sicker patients across a wider selection of healthy ones, experts have argued.
  • The third bill would change the ACA’s grace period for enrollees receiving premium tax credits to catch up on missed premiums, shortening it from 90 to 30 days. Some insurers feel that enrollees are gaming the current grace period, according to the Health Affairs post.
  • The final bill states that an ACA replacement should ban insurers from denying coverage to individuals with preexisting conditions clauses and guarantee issuance of insurance through both employers and the individual market. Trump has said previously that he wants to keep the ban on preexisting coverage clauses. 

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