Quick look at House budget reconciliation recommendations on Affordable Care Act

The committee print of recommended legislative provisions to amend the Patient Protection and Affordable Care Act using the Congressional budget reconciliation process is out today. The budget reconciliation measure marks the beginning of the Trump administration’s efforts to overhaul at least Titles I and II of the Affordable Care Act. Health and Human Services Secretary Tom Price indicated additional legislation will be necessary in a letter to the chairmen of the two House committees processing the reconciliation bill, The Washington Post reported. Here is a quick roundup of its provisions:


  • Establishes per capita state plan funding formula.
  • Ends expanded Medicaid eligibility option for states at the end of 2019.
  • Provides $2 billion annually from 2018 to 2022 to non-expansion states for higher federal cost shares, allocated based on the number of state residents earning less than 138 percent of federal poverty.
  • Requires states to make eligibility determinations every six months.

Other provisions

  • Repeals reduced cost sharing subsidies for silver actuarial value qualified individual health plans for households earning between 100 and 250 percent of federal poverty.
  • Establishes a $100 billion “Patient and State Stability Fund” for years 2018 through 2026 to assist states cover high risk individuals and reimburse health plan issuers for claims exceeding $50,000 and up to $350,000 starting in 2020. States would be required to contribute to the fund, with the amount increasing each year.
  • Authorizes individual and small group health plan issuers to levy a 30 percent premium surcharge for individuals who fail to maintain continuous medical coverage.
  • Increases the allowable spread for age as a premium rating factor between the oldest and youngest plan members to 5 to 1 from the current 3 to 1.
  • Repeals the annual fee on health plan issuers.
  • Eliminates income-based advance premium tax credits paid to health plans for exchange purchased plans effective January 1, 2020 and instead authorizes age-based tax credits, payable in advance to health plans.
  • Zeros out the penalties for noncompliance with the individual and employer shared responsibility mandates effective January 1, 2016.
  • Increases the maximum annual health savings account contribution to the amount of the annual deductible and out of pocket limitation.

Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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Frederick Pilot

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