House Democrats Propose ACA Reforms

April 1, 2019

Democratic leadership in the US House of Representatives last week proposed several reforms to stabilize and improve the Affordable Care Act (ACA). Their legislation, the Protecting Pre-Existing Conditions & Making Health Care More Affordable Act of 2019, would also roll back the Trump Administration’s efforts to undermine the ACA.

Specific reforms to make coverage more affordable include:

  • Enhanced tax credits for individuals who purchase marketplace coverage: The bill would improve tax credits for individuals earning below 400% of the Federal Poverty Level (FPL) by reducing required premium contributions. It also would, for the first time, provide tax credits to individuals earning above 400% FPL by capping required premium contributions at 8.5% of income.
  • “Family Glitch” Fix: Under the ACA, tax credits are not available for workers with access to affordable employer-based coverage, which the Internal Revenue Service has interpreted to apply to individuals and their families. This means that a family will not qualify for subsidies if a worker is offered affordable individual coverage from an employer, even if the employer does not offer affordable family coverage. The bill would fix this so that families without access to affordable family coverage from their employer can qualify for ACA subsidies.
  • Establishing state-based reinsurance programs: The bill gives state reinsurance programs funding to reduce premiums, provide additional premium support, or reduce enrollee cost-sharing.

Reforms to reverse certain Trump Administration policies include:

  • Preserving ACA protections: The bill would prohibit implementation of regulations that expand the availability of association health plans that weaken the individual and small group market and make short-term, limited-duration policies available. Such policies do not offer ACA protections such as prohibitions on preexisting condition limitations, and they are not required to offer comprehensive coverage.
  • Funding for Navigators, Outreach, and Education: The bill would restore funding for these activities, which the Trump Administration substantially reduced, and would prohibit using the funding for other purposes.

The bill would also give states funding to pursue innovative policies to promote and expand coverage, including implementation of state individual mandates. In addition, funding would again be made available to states that wish to establish state-based marketplaces.

The Republican-led Senate is unlikely to take up the House’s proposed ACA reforms, and the future of the existing law remains uncertain in light of continued litigation. The reform bill arrives on the heels of the Trump Administration’s announcement of agreement with the judge’s decision (currently under appeal) in Texas vs. United States that the entire ACA must be invalidated due to repeal of the individual mandate penalty. This is a reversal of the Administration’s previous position that only portions of the ACA should be invalidated. Given the continued divergent Republican and Democratic positions on the ACA’s future, health care will likely remain a hot topic in the 2020 election.