New changes don't fix AHCA shortcomings, threaten key protections

April 30, 2017
Apr 27, 2017

American Medical Association Wire

The most recent effort to broaden support for the American Health Care Act (AHCA), which comes in the form of an amendment proposed by New Jersey Rep. Tom MacArthur, does not address the most serious flaws in the bill and would also undermine critical health insurance consumer protections. For these reasons, the AMA “remains opposed to passage of this legislation,” the Association’s CEO and Executive Vice President, James L. Madara, MD, said today in a letter to House Republican and Democratic leaders.

The amendment would let states ask the federal government for waivers from various health insurance marketplace regulations. These include the rule that limits to a three-to-one ratio how widely insurance premiums can vary based on age; the requirement that insurers must cover certain essential health benefits, such as maternity care, hospitalization and prescription drugs; and the ban on health-status underwriting.

That last change is especially troubling. Prior to the ban on health-status underwriting, insurers routinely discriminated against patients based on their medical conditions by denying coverage outright or pricing patients out of affordable coverage.

“Although the MacArthur amendment states that the ban on pre-existing conditions remains intact, this assurance may be illusory as health status underwriting could effectively make coverage completely unaffordable to people with pre-existing conditions,” Dr. Madara wrote.

States seeking to allow health-status underwriting would have to operate a program to give financial assistance to high-risk individuals seeking coverage in the individual market, offer a reinsurance program to entice insurers to serve these patients, or take part in a high-risk sharing program designed to reinsure high-cost states.

But, Dr. Madara wrote, there is “no certainty” that these efforts “will be sufficient to provide for affordable health insurance or prevent discrimination against individuals with certain high-cost medical conditions.”

Further, he added, “nothing in the MacArthur amendment remedies the shortcomings of the underlying bill,” which the Congressional Budget Office has projected would result in 24 million more uninsured Americans by 2026 when compared with current law. A core principle guiding the AMA’s discussions on health system reform is that proposals should not cause people who have health insurance coverage now to lose it.

This third major version of the HCA “does not offer a clear long-term framework for stabilizing and strengthening the individual health insurance market to ensure that low- and moderate-income patients are able to secure affordable and adequate coverage, nor does it ensure that Medicaid and other critical safety net programs are maintained and adequately funded,” Dr. Madara’s wrote.

The AMA weighed in on the first and second versions of the AHCA, both times raising major concerns about their impact on the 20-plus million Americans who have gained health insurance coverage in recent years.

The AMA has set forth a comprehensive vision for health-system reform refined over more than two decades by the AMA’s House of Delegates, which is composed of representatives of more than 190 state and national specialty medical associations. That vision is guiding the AMA as it works, on a nonpartisan basis, with Congress and the president to improve the nation’s health system.

More information is available at, which offers patients and physicians an easy way to learn about the AMA’s policy priorities and make their voices heard on these vital issues. The AMA Wire® special series, “Envisioning Health Reform,” details the policy foundations of the AMA’s health reform objectives.


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