Health care politics Still, should Republicans retake the House and Donald Trump be reelected, it could breathe new life into the AHCA. (Photo: Shutterstock)

Everything old is new again—at least when it's a Republican plan to do away with the Affordable Care Act.

Fierce Healthcare reports that a "new" health care plan produced by the Republican Study Committee—a group of 145 House Republicans—looks an awful lot like the American Health Care Act, which Republicans passed in 2017 when they still held the House majority. And the AHCA was actually a big motivator behind voters' handing a loss of their majority to House Republicans.

Still, should Republicans retake the House and Donald Trump be reelected, it could breathe new life into the AHCA. In that case, here are some of the changes it would propose.

While the plan would continue to require, as does the ACA, that pre-existing conditions be covered, it would change how that happens by devolving to high-risk pools that would, according to the report, "be funded by repackaging the funding used for the ACA's subsidies and the Medicaid expansion."

The trouble with that is that the new plan doesn't specify how much funding should be put towards those high-risk pools, which, according to a 2017 Milliman report, could require between $3.3–$16.7 billion a year. When the AHCA championed high-risk pools, it only advocated providing $2.5 billion annually to fund them—and there's no assurance that funding provided by this latest take would come up to scratch either.

The plan also advocates again for Health Savings Accounts and proposes substantial boosts in allowable contributions: $9,000 per individual and $18,000 for families. It would also allow HSA funds to be used for health services and products that currently are not approved for pretax-dollar purchase.

The plan purports to improve health coverage portability but allows people to be subject to an exclusion period for preexisting conditions if they haven't had a year's worth of continuous coverage—although there are provisions to shorten that exclusion period and "the 63-day grace period for gaps in coverage would be maintained under the RSC plan," the RSC report says.

Last but not least, it would drop current Medicaid expansion funding back to pre-expansion levels while replacing the current open-ended structure with block grants. It adds a "flex-grant" aspect that would provide states adding work requirements with more money than states that lack them. Half of that additional funding, however, must go toward private plan purchase for low-income participants.

In addition, the fly in the ointment here is that of the 12 states that have already gotten approval from the Trump administration to add work requirements, three have already had those work requirements struck down in court.

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Marlene Satter

Marlene Y. Satter has worked in and written about the financial industry for decades.