What are the some of the major differences between the amended Republican American Health Care Act (AHCA) which was released on Apr 22 to the original one which voting was cancelled due to the lack of votes for it to be passed?

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The American Health Care Act was initially proposed in Mar 20 but was eventually withdrawn due to the lack of support, particularly from members of the House Freedom Caucus.

Subsequently, U.S. Rep. Tom MacArthur (R - NJ) offered an amendment to the bill that aims at toughening Medicaid rules for adults.

The original text of the bill can be found here and the amendment can be found here.

Basically, many of the new changes are aimed at Medicaid.

1. Add work requirement to Medicaid:

States can now require able-bodied Medicaid recipients to work, participate in job training programs or do community service.

2. Let states pick block grant funding

States could opt to receive a fixed amount of federal funding each year, regardless of how many participants are in the program, thus reducing federal support as funding won't adjust for increases in enrollment.

3. Ban new states from expanding Medicaid

This will prevent additional states from expanding Medicaid. Under the original bill, enhanced funding for Medicaid would be repealed as of January 1, 2020, but nothing barred states from expanding the program before that.

4. Give upstate counties in New York relief from Medicaid payments

This would ban the federal government from reimbursing New York State for Medicaid funds raised by counties outside New York City. The upstate counties send $2.3 billion to the state to help pay for Medicaid.

The amendment would give the state the incentive to stop passing down Medicaid costs to the counties.

5. Pushes provision for bigger tax credits for older Americans to Senate

The House is setting aside funds to provide additional tax credits to help people buy policies on the individual market, but they are letting the Senate handle the crafting of the legislation. Many older consumers would face huge premium hikes under the GOP bill because its tax credits are not as generous as Obamacare's subsidies for lower-income enrollees in their 50s and early 60s. As a result, the premium for a 64-year-old would be 20% to 25% higher in 2026 than it would be under Obamacare, the CBO projected.

6. Make it easier for taxpayers to deduct medical expenses

Taxpayers could deduct medical expenses above 5.8% of their adjusted gross income. Under Obamacare, the threshold was raised to 10%. Prior to that, it was 7.5%. The change would take effect this year, instead of in 2018.

7. Repeal Obamacare taxes this year

Now the bill would eliminate Obamacare's taxes on wealthy individuals, insurers, prescription drug makers and others this year instead of in 2018. It would also delay the start of the Cadillac tax on generous employer plans in 2026, instead of 2025.

8. Ban excess tax credits from going into Health Savings Accounts

Enrollees whose tax credits exceed the cost of their premiums will no longer be able to put the additional funds in Health Savings Accounts. Some conservatives were concerned these funds could be used to pay for abortions.


  • It would also be helpful to address the "essential health benefits" being specified by states and the ability to set premiums based on "health status".
    – bwarner
    Commented May 2, 2017 at 16:47
  • Very few of these changes sound particularly appetizing (at least to my own personal political and social beliefs). Can someone provide a "positive" viewpoint and explain how these changes will affect a change for the better in the health of the general population - or at least how are these changes in-line with the "greater freedom of healthcare" line extolled by the GOP?
    – Dai
    Commented May 2, 2017 at 19:12
  • 1
    @Dai under the Affordable Care Act people like myself, young and relatively healthy, would be "encouraged" to purchase health insurance. under this new plan it would be more cost effective to drop health insurance entirely and place my money into a Health Savings Account, which is pretax.
    – Reed
    Commented May 2, 2017 at 20:46
  • 2
    @Reed does that work if you get sick almost immediately? You have a tiny amount in savings, and you have no insurance. Are you screwed, or is there something I'm missing?
    – rob
    Commented May 2, 2017 at 23:58
  • @rob, freedom to make your own choices comes with freedom to make your own mistakes. To prevent anything bad from happening to anybody ever, you must take away everyone's power of choice completely. Slaves are made by giving them freedom from responsibility.
    – Wildcard
    Commented May 3, 2017 at 0:11

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