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Michael Petruzzelli

, National Council for Behavioral Health

Group of GOP Legislators Introduces Health Reform Legislation

February 10, 2015 | Medicaid | Comments
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Three key Republicans members of Congress unveiled legislation to repeal and replace the Affordable Care Act, presenting the latest alternative to GOP lawmakers who have long debated how to supplant President Obama’s chief legislative accomplishment. The legislation – introduced by Sen. Richard Burr (R-NC), Senate Finance Chairman Orrin Hatch (R-UT), and House Energy and Commerce Chairman Fred Upton (R-MI)—would impose per-capita caps on federal Medicaid spending and would repeal the Affordable Care Act’s individual and employer insurance coverage mandates.

The health reform bill, entitled the Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act, was originally a Senate-only bill, first introduced last year by Senators Tom Coburn (OK), Burr, and Hatch. With the addition of Representative Upton, the legislation now has support from key legislators in the most important health care committees from both chambers of Congress.

Among the key provisions of the Patient CARE Act:

  • Medicaid Reforms – Under the Patient CARE Act, the federal government would adopt a per-capita funding scheme for Medicaid, where federal Medicaid dollars would “follow the patient.” Each state’s capped allotment would be based on the number of enrollees and their health status, age, and life circumstances.  Funding for health grants would be allocated to states based on the number of low-income enrollees at or below 100 percent of FPL.  States would receive a defined budget for long-term care services and support for low-income elderly or disabled individuals who do not avail themselves of the tax credit.
  • Individual Mandate, Pre-Existing ConditionsThe bill would repeal the current individual mandate, which ACA supporters argued is necessary to end discrimination against those with pre-existing conditions. The Patient CARE Act would also prevent insurance companies from denying coverage to patients based on a preexisting condition if the patient is continuously enrolled in a health plan.
  • Auto-Enrollment – States could elect to auto-enroll qualified individuals into insurance plans with premiums equal to the value of the individual’s tax credit, but who fail to make an affirmative choice in choosing a plan within a specified timeframe.
  • Additional Insurance Regulations – The Patient CARE Act includes a number of other insurance regulations and consumer protections, including: no lifetime limits on coverage; a requirement for plans to offer dependent coverage up to age 26; and guaranteed renewability.
  • Subsidies The plan would provide a tax credit for individuals with incomes up to 300 percent of the Federal Poverty Level (FPL). Instead of being determined by the cost of insurance, subsidies will be adjusted by age and family status. In addition, subsidies will be available to individuals below the poverty line, a change from the ACA, which expanded Medicaid eligibility to cover the poor.

Though ACA opponents have not yet been able to find the votes they need to pass a “repeal-and-replace” plan, the issue has taken on new prominence as the Supreme Court considers a case that could decimate the law’s subsidies and require a major overhaul of the health insurance marketplaces.