House Republicans are debating a proposed compromise that might help them revive stalled legislation to roll back much of Democratic President Barack Obama’s health care law. The broader bill would rework subsidies for private insurance, limit federal spending on Medicaid for low-income people and cut taxes on upper-income individuals used to finance Obama’s overhaul.
Here’s a look at key elements of the compromise, authored by Rep. Tom MacArthur, R-N.J.:
— States could apply to the federal government for expedited waivers from certain provisions of the Affordable Care Act, or ACA, which Obama signed into law in 2010. Some waivers could be in place as early as next year.
— States would have to explain how their proposals would advance one or more goals, such as reducing average premiums, increasing health insurance coverage, stabilizing the market for individually purchased policies, increasing choice or stabilizing coverage for people with pre-existing health problems. That’s a lesser threshold for approval than state waivers in the current law.
— The Department of Health and Human Services would have 60 days to review the application. Federal approval would be deemed the default in most cases.
— For coverage starting as early as next year, states could seek waivers of federal restrictions on premiums charged to older adults. The ACA limits insurers from charging older adults more than 3 times what young adults pay. The underlying GOP bill has a 5-to-1 limit. The amendment would allow states to seek a higher ratio. That would make more low-premium plans available for people in their 20s and 30s but raise rates for those in their 50s and early 60s.
— For individual or small business coverage starting in 2020, states could seek waivers of the ACA’s “essential health benefits” requirements. Among the 10 categories of benefits are hospital and outpatient care; pregnancy, childbirth and newborn care; mental health and substance abuse treatment; prescription drugs; lab tests; kids’ vision and dental care, and rehabilitative care. Waiving essential benefits could make more low-premium plans generally available, but insurance could be less comprehensive for people with complex medical conditions.
— Starting in 2019, states that have certain safeguards in place — such as a high-risk pool — can seek waivers from the ACA provision that prohibits insurers from charging higher premiums to people with health problems. Insurers could charge higher premiums only to certain people, those who have had a break in coverage. While they would still have access to coverage, some may not be able to afford it.