There’s been an ongoing debate since reform was first enacted about the possible merits of employers eventually exiting health care benefits altogether and moving employees en masse into the public marketplace. Stirring the pot most recently is financial industry research firm S&P Capital IQ, which estimates that by 2020 — just five years from now — 90% of American workers who currently receive health insurance through their employers will be shifted to government exchanges. S&P authors cite rosy bottom lines, trickle-down increases in employee pay and benefits, and the lure of federal subsidies for low-wage workers as the impetus for the grand exodus.
But these projections fly directly in the face of data systematically collected through Mercer’s National Survey of Employer-Sponsored Health Plans — and of the strategies employers are using successfully to manage spending and stay competitive. Most large US employers — 94% in 2013 — remain committed to offering employer-sponsored health plans for at least the next five years. Even among the smallest employers — those with just 10 to 49 employees and the least inclined to offer coverage to begin with — only 34% of current health plan sponsors say they are they are “likely” or “very likely” to terminate health coverage within the next five years.
Still, for those who remain skeptical, I offer three compelling reasons why so many employers have decided to stay the course.
1. Employees value health benefits as highly as pay.
An overwhelming 93% of employees say their health care benefits are as important as their pay. Every year, the Mercer Workplace Survey asks approximately 1,500 US employees who have medical and 401(k) plans to value their benefits. Even as deductibles have risen and benefits have become less rich, these results have strengthened over time, sending a clear message to employers: To attract and retain the best talent, you must stay in the game.
2. The public marketplace remains a huge unknown.
The exchanges may be here to stay, but the fate of plan rates and the true benefits of the public marketplace as an exit strategy are very much up for grabs. To walk away from health benefits now would introduce far too much financial risk to employers that are already in dire need of predictability and proven cost-effectiveness.
3. The math doesn’t work — for employers or employees.
The tax implications for employers constitute a triple whammy. First, they will pay the $2,000 per-person penalty (and that amount is indexed; it goes up each year). Then, they will lose the tax deduction on that money, in turn reducing the funding available to employees to purchase coverage through the public marketplace. Finally, whatever money they might add into paychecks to help employees purchase benefits on a public exchange will be subject to payroll taxes, thus reducing its value as a substitute for employer-provided benefits.
On average, health benefits cost $10,779 per employee in 2013, according to Mercer’s research, with the employee typically picking up about 20% of this cost — or about $2,200. However, most employees will pay far more than that for individual coverage in the public marketplace, and families will take an even harder hit — the lowest-level public exchange plan on average costs $20,000 a year for a family of four. Only the 25% or so with incomes below 400% of the federal poverty level are eligible for government subsidies.
As organizations continue to sort through the expanding options in today’s new order of health benefits provision, one thing is certain: A full-scale exit at the expense of talent, predictability, and affordability — for both employers and employees — remains a highly unlikely proposition.
While I spend most of my work days helping large employers with their health benefit programs, this past week I wore my Mercer health reform leader hat at my own personal version of health policy summer camp in Washington. I spent two days with the American Benefits Council’s policy board, took some meetings on Capitol Hill, and visited with Julie Rovner and Julie Appleby at KAISER Health News.
While employers have their hands full managing health benefits for their own employees and their families, don't underestimate their interest in the individual market and their concern for the public exchanges. In a series of meetings that ABC arranged on Capitol Hill and with Trump administration staff to discuss key issues for employers, the topic of the federal government’s commitment to cost-sharing reduction subsidies for individual policies sold on the exchange came up every time. CSR subsidies are central to the financial success of exchange business, and, though continuing them for now, the Trump administration won’t commit to future payments. Earlier this week, Republicans received another 90-day delay to consider how they’d like to proceed in the appeal of a case the House brought last year challenging the CSR subsidies. Without these payments, the insurance companies writing these policies are at risk for reimbursement that the federal government is contractually obligated to pay.
Employers do not want the individual market to crumble. Not only is that bad for people who depend on it -- including early retirees and former employees -- but cost pressures in the individual market will inevitably lead to cost shifting to private payers. My colleague Geoff Manville and I had a great conversation with Julie Rovner and Julie Appleby at KAISER about the problems creating instability in the individual market. My top three coming out of that discussion:
- Small risk pools. It was clear going in that the risk pool was not going to be ideal, but on top of that, many states are not big enough on their own to generate enough lives to create a stable risk pool. While 100,000+ lives may sound like a big group, when you divide it across multiple insurance companies and a variety of products, the "law of large numbers" doesn't work because the numbers aren't large enough. Look back 15 years when the biggest employers offered multiple self-insured plans and 10-15 insured HMOs -- and look at what they offer now. The past 10 years have seen a lot of plan consolidation.
- Young insureds MIA. One of the most popular ACA provisions, expanded group plan eligibility to include dependents up to age 26, was detrimental to individual plans. The biggest decrease in the uninsured occurred in the younger end of the market. Unfortunately for insurance companies, most of these younger Americans got coverage through their parents, not by purchasing it in the individual market.
- Federal government missteps. The government has not been the best business partner to insurers. To pick one example, think back to how essential health benefits were handled. As the public exchange implementation was coming down to the wire, there was an outcry from current individual policy holders facing significant premium increases for broader coverage that included all EHBs. At the last minute, the White House decided to "grandmother" those plans, which meant that insurance companies lost the additional revenue they were counting on from those policies. And now they face possible nonpayment of promised CSR subsidies.
What is the long-term future of the individual market? Some insurance companies have already declined to continue offer coverage in the public exchange in 2018 and others are still deliberating. We are in dire need of some leadership from the government to uphold their end of the bargain with the insurance companies. The individual market -- and people's lives -- are at stake.
Earlier this week, we hosted a Mercer Select Briefing and asked participants to ponder changes they might make to their health benefits if the ACA’s employer mandate were fully or partially repealed. Of the 175 employers taking the poll, relatively few anticipate making any particular change. The largest number of respondents – 21% – said they would be likely to set higher employee contributions for individual coverage than currently permitted under the affordability requirement. Given that many employers have added lower-cost plans since the ACA was signed, most don’t have an issue with affordable contributions. Just 19% said they would be likely to resume a 40-hour work-week requirement for eligibility (rather than the 30-hour requirement under the ACA) and the same percentage said they would likely revisit lifetime benefit dollar limits. Fewer than one in ten employers thought they might impose pre-existing condition limitations, and almost none said they were likely to require more than a 90-day waiting period for benefits.
The truth is, in employer-sponsored plans the burden of compliance was greater than the impact of compliance. Now that we are there, it is unlikely there will be a race to unravel the changes. Probably the two biggest ACA issues for employers that remain are the excise tax (delayed until 2020) and the ongoing reporting requirements. The current version of the AHCA further delays the excise tax, and regulators are well aware of employers’ desire for relief around reporting. We keep hearing that change is coming, but change takes time in Washington DC.
The anxiously awaited CBO score of the AHCA – reflecting the last round of changes made to the bill before it was passed – was released yesterday afternoon. The nonpartisan scorekeeping office forecast the AHCA would cut the federal deficit by $119 billion over the next 10 years, down from $150 billion in the prior score. From a process perspective, the bill still easily passed the test to save at least $2 billion to qualify for consideration under a reconciliation process that is filibuster-proof by requiring only 51 votes in the Senate, not the typical 60-vote threshold.
What else changed in the report? There was a very small decrease in the projected number of uninsured, which had been 24 million over ten years and was revised to 23 million. That’s not much of a ROI for the additional $38 billion aimed at keeping people covered. The largest savings stem from reductions in Medicaid funding and from the replacing ACA’s subsidies for individual health insurance with new tax credits for individual/non-group health insurance.
Of particular interest to employers are the waivers that could be granted to states starting in 2020 allowing them more flexibility on age rating and essential health benefits. In scoring the bill, the CBO and JCT examined three general approaches states could take to implement H.R. 1628 and estimate that about half the population resides in states that would not request waivers regarding the EHBs or community rating; about one-third of the population resides in states that would make moderate changes to market regulations, and about one-sixth of the population resides in states that would obtain waivers involving both the EHBs and community rating. There’s a table showing the estimated impact on premiums by age group in states that would and wouldn’t obtain waivers in this Vox article, and the story isn’t good for older Americans. It’s not yet clear how, or whether, state waivers – which are targeted for individual and small group coverage – would affect employer-sponsored plans.
Politico summed it up best, “…the report highlights the central dilemma that Republicans are grappling with now — how to write a health care bill that preserves peoples’ coverage at a reasonable price, without resorting to government mandates and billions in federal spending. And it drops that problem right on the Senate’s doorstep.”
Many Americans and employers agree that a top priority for President Trump and Congress should be lowering prescription drug costs. That was underscored this week with introduction of bipartisan legislation – the Fair Drug Pricing Act – a step in the direction of greater price transparency. The bill would require drug makers to justify their pricing and itemize their expenses before raising prices more than 10% in one year, or 25% over three years, on drugs that cost at least $100. (Remember the EpiPen controversy from last year?) Shortly after receipt of this pricing information, HHS would be required to make the data publicly available. In addition to providing a check on sharp price hikes, this could help PBMs and other drug purchasers make more informed decisions.
The Fair Drug Pricing Act mimics bills that have been introduced in more than a dozen state legislatures, and a growing number of state and federal lawmakers have offered a variety of proposals to address the issue. Congressional Democrats, for example, have proposed to allow Medicare to negotiate prices, remove tax breaks drug makers receive for advertising expenses, speed generic drugs to market, and allow Americans to import medicines from Canada, among other things.
The pharmaceutical industry opposes and will fight most of the proposals, but it’s clear that the industry and policymakers are feeling the heat over drug prices.
While working women continue to earn less money than their male counterparts, the gap is narrowing when it comes to health benefits. Three years ago, we used data from Mercer’s National Survey of Employer-Sponsored Health Plans to examine the difference in benefits between large employers with workforces that are 65% female or more to those with workforces that are 65% male or more. Just under half of the mostly female companies are in health care and a quarter are in the services sector, while mostly male companies are found predominately in the manufacturing industry (52%). The percentage of employees in collective bargaining agreements has remained about the same for the two groups (13% for companies with mostly female employees and 15% for companies with mostly male employees). One workforce statistic has seen some movement since 2013, when the average salary for mostly female companies was about $10,000 less than when the workforce is mostly male; data from our 2016 survey shows the difference is now over $15,000. That’s right – the gap in the average salaries of companies with mostly female vs. mostly male workers has only gotten wider.
The health benefits at organizations with predominantly female workforces continue to be less generous than in those with predominantly male workforces. In addition, the employee contributions for these less generous plans are higher than those for the richer benefits offered to employees at mostly male companies. For coverage in a PPO, the most common type of medical plan, the monthly contribution for family coverage is 17% higher ($484 for mostly female companies and $415 for mostly male companies), which is down from a 31% difference in 2013.
In addition, average in-network and out-of-network deductibles and out-of-pocket maximums are consistently higher. For example, the average in-network PPO deductibles in mostly female companies are $844 and $1,936, respectively, for individual and family coverage, compared to $767 and $1,729 at mostly male companies. While the average deductibles for mostly female companies are still higher, the gap has narrowed when compared to 2013 average deductibles.
While benefits for mostly female companies continue to be less rich and more expensive overall, the gap between these benefits and those for mostly male companies does seem to have narrowed since 2013 and since the implementation of the ACA’s employer shared responsibility affordability and minimum values rules, which set thresholds for the amount an employer can charge an employee for their health plan and for the percent of charges the health plan must cover, broadly speaking. However, the gaps in health plan benefits and costs still exist -- and are compounded by the lower salary levels for employees in companies with higher concentrations of women workers.
Republican senators will continue discussions this week on revisions to legislation narrowly approved by the House -– the American Health Care Act – to repeal and replace much of the Affordable Care Act (ACA). Passing a bill out of the Senate may be an even tougher fight for Republicans, who can’t afford more than two defections.
The talks are driven in part by concerns of moderate GOP senators about the House bill’s creation of a waiver system that could substantially raise premiums for certain individuals. The waivers would let states opt out of ACA insurance standards for age rating and “essential health benefits” (EHBs) and, in certain cases, community rating protections related to pre-existing conditions. A number of centrist senators also want to make the bill’s refundable tax credits more generous -- particularly for the elderly -- and delay its phase-out of the ACA’s Medicaid expansion.
While much of the discussion aimed at bridging the conservative-centrist divide is being led by an official working group of 13 lawmakers appointed by Senate Republican leadership, members of the group say they are soliciting the views of all GOP members. Senate Republican leaders say there is no set timeline for legislation but face immense pressure to produce a proposal in short order so they can move to tax reform and other parts of their legislative agenda.
The debate will likely intensify next week, when the Congressional Budget Office is expected to release its analysis of the House-passed bill. The forthcoming score will reflect the language creating the state waiver system added to the bill just before House approval. To avoid a Democratic filibuster, Senate “reconciliation” rules will force the GOP to remove provisions that do not affect the budget.
If a bill passes the Senate, House Republicans could finish the process by passing the Senate’s bill without amending it. Alternatively, Republicans could iron out differences in a “conference committee” comprised of members from both chambers. Hard-line conservatives in the House may object to the Senate’s changes, which are likely to water down some of the American Health Care Act’s major provisions. The two chambers must agree on a uniform bill, however, before it can be sent to the president.
Earlier this week we learned that the CBO will release their “score” of the AHCA the week of May 22. This revised projection will reflect the most recent changes to the bill – allowing states to opt-out of certain provisions including essential health benefits, aspects of community rating and changes to age banding ratios as well as $8 billion in funding to help states that choose to waive the ACA's community rating for individuals who don't have continuous coverage.
This CBO score will play a key role in how the bill moves through the Senate. The Senate Parliamentarian determines which provisions of the bill qualify for repeal under the budget reconciliation process, and she cannot begin that review without the CBO analysis. If she decides that certain parts of the AHCA bill can’t be part of the reconciliation bill, that would affect the CBO score, especially the estimated savings that impact the amount of deficit reduction. This deficit reduction estimate – $150 billion for an earlier version of the bill – will constrain how the Senate crafts their bill. The reconciliation rules require the Senate bill to achieve the same level of savings as the House bill.
As this article from The Washington Post points out, if Senate Republicans want to reinstate some of the Medicaid spending cut by the House, they’ll need to find revenue to pay for it, meaning they may have to reconsider when and which of the ACA’s long list of taxes can be repealed – the AHCA would delay the Cadillac tax until 2026 but would repeal most of the ACA's other taxes starting in 2017. This budget constraint rule also almost guarantees an uphill battle for the Senate to repeal the Cadillac Tax. Not only would Cadillac tax repeal raise a budget “point of order” requiring 60 votes to waive, it would come with some costs which they might not be able to offset if the Senate wishes to walk back some of the savings generated from changes the AHCA would make to Medicaid and the individual market. If the new CBO score continues to project a large increase in the number of uninsured – 24 million more uninsured by 2026 in the last report – the Senate will be under pressure to keep ACA changes to Medicaid and the individual market or simply make smaller fixes to these provisions. All eyes will be on the CBO score that comes out the week of May 22 as the starting point for the Senate debate.
With all the uncertainties around healthcare legislation swirling, cost control of pharmacy spend remains top priority for employers. On one hand, employers obviously want their employees to have access to the medications they need: drugs like insulin, blood pressure treatments, and cholesterol blockers have long played a critical role in employees’ health. But now new specialty biotech drugs – some of them true medical breakthroughs – are flooding into the market, at costs much higher than previous therapies. Drug prices spiked by 9.8% between May 2015 and May 2016, and there are more sharp increases ahead. Drug costs are quickly becoming unsustainable, for both employers and, increasingly, plan members. Many high-cost brand name drugs may have rebates to reduce their net cost, but the member or patient typically does not see these rebates so their out-of-pocket cost is still high. And even the cost of some generic drugs has risen dramatically.
Fingers are being pointed everywhere—from regulations and research to the cost of lawsuits when new drugs perform poorly. While other stakeholders work on those issues, there are actions employers can take to shift the equation in their favor. Here are a few ideas:
Analyze the data on prescription drug spend in your plan
Prescription drugs are the top driver of health benefit cost increases today. In a recent report by the Pharmacy Benefit Management Institute, pharmacy benefit costs increased 10.2%, driven by 19.2% growth in specialty pharmaceuticals.
It’s important to know what’s driving cost growth in your program. When looking at your data, here are a few things to focus on:
- Drugs – What drugs are plan members using?
- Channel – From where patients receive their drugs and are they leveraging the lowest-cost channels?
- Supplier – Are you maximizing the prescription benefit manager relationships?
- Care – How do the drug therapies match up to best practices and evidence based medicine?
Educate employees on what they can do to lower their Rx costs
Employers can help employees be smarter when talking to their physician about their medications and making purchasing decisions. If your program includes any of these cost-saving Rx benefit features, make sure your employees understand them:
- Lower copays for generic drugs
- Lower copays for drugs in formularies
- Preferred pharmacies
- Mail-order suppliers
- Prior authorization requirements
- Step therapy requirements (members try lower-cost drugs first before they can move up to higher-cost prescriptions)
Focus on specialty drugs now
Specialty drugs for complex conditions account for 38% of all prescription spending even though they are used to treat about 1 to 2% of all patients. (Consider this recent example of how one employer discovered just two plan members were accounting for 2.5% of their total health budget due to specialty medication prescriptions.) The most expensive biologic breakthrough treatment regimens can exceed $750,000 per year. For the entire US healthcare market, specialty medication spending has nearly doubled since 2011, reaching more than $160 billion. With 40-50 new specialty medications set to enter the market each year, there is no end in sight.
To help gain control over your spending on specialty drugs, consider working with an expert to conduct a specialty diagnostic of medical and pharmacy plans to assess the current state and identify areas for improved management. Once the diagnostic results are in, employers can make informed decisions on revisions to their plan structure. We see savings typically in the 5-10% range. However, these savings occur in the short-term, and so it is a good idea to revisit the plan structure at least semi-annually as provider capabilities change over time.
If you’d like to learn more about the specialty pharmacy topic, join me for an upcoming webcast hosted in partnership with HR.com on May 17. We will explore the specialty pharmacy ecosystem and discuss options to stay ahead of the cost curve.
For more on Specialty Rx, please read David’s recent article in Benefits Quarterly.
The vote to pass the AHCA in the House – a first step on the road to repealing the ACA – has raised questions about how employers might respond if the ACA requirements affecting employer-sponsored plans were to be lifted. One way to approach that question is to look at how employer plans changed – and how they didn’t change – under the ACA. We went back to past Mercer National Survey of Employer-Sponsored Health Plans databases to find out.
- Eligibility. While 22% of employers with 50 or more employees (and 37% of those with 500 or more employees) said they would need to make changes because of the ACA’s 30 hour rule in 2015, we’ve seen no evidence that enrollment in employer plans has risen as a result.
- Mini-meds. Before the ACA, 7% of all large employers (and 21% of large retail employers) offered mini-med plans, generally to their part-time employees. The 60% plan value rule effectively put an end to mini-meds.
- Affordable contributions. Only 14% of respondents to our 2014 survey on health care reform said they would need to take steps to meet the ACA’s affordability rules. Employers have historically been slow to raise contributions as a percent of premium. The average contribution for employee-only coverage in a PPO plan was 24% in 2009, the year the ACA was signed, and it was 24% in 2016. The average dollar contribution has risen along with plan costs, but proportionally, contributions have not increased.
- Deductibles. Whether this was an intended or unintended consequence, deductibles have risen sharply under the threat of the ACA’s excise tax. Since 2010, the average individual PPO deductible has risen by an average of 7% annually, faster than overall growth in medical plan cost.
- Lifetime limits. In 2009, 71% of large employers had lifetime benefit maximums in their PPO plans and the median limitation used was $2,000,000. While it was rare that a plan member would reach the maximum benefit amount, the ACA outlawed the use of lifetime limits entirely.
Would a repeal mean that employers revert back to pre-ACA plan designs? Not necessarily, and certainly not at once. Some employers might reinstate mini-med plans as a way to provide some type of health benefit to part-timers not eligible for the company’s comprehensive plan. It seems unlikely that employers that have raised deductibles would lower them – but it also seems unlikely that employers would take away coverage from any employees or reduce plan values below the current 60% minimum. Before the ACA, most employers voluntarily offered comprehensive health benefits that already met the ACA minimum requirements; by and large, the requirements targeted plans that were the exception rather than rule.
The repeal and replace bill that just passed in the House faces tough challenges in the Senate. Even so, with the Senate reportedly working on a bill of their own, it’s a good bet that this Congress will make some changes to the ACA – and, one way or another, that will mean change for employer plans too. This process may take some time. We’ll keep you posted.
Well, it happened. House Republicans got the votes to send the AHCA on to the Senate. The bill will face tough challenges in the Senate, so this is far from a done deal. For now, it is business as usual under the ACA.
Highlights of what is in HR 1628
- The “Cadillac” tax remains, although delayed from 2020 to 2026
- Employer and individual mandate penalties eliminated for 2016 and later years
- Age-based tax credits starting in 2020. Credits phase out for those making more than $75,000 per year ($150,000 joint filers). No credits for those offered employer coverage
- Most other ACA taxes are repealed for years beginning after 2016
- HSA enhancements – Increase limits to max deductible/out-of-pocket limits for HDHPs (Based on Mercer estimates, $6,650 single/$13,300 family for 2018)
- No additional states can expand Medicaid after March 1, 2017 and Medicaid funding significantly changed with per enrollee capped payments, option for block grants
- Employer’s ACA reporting not repealed (this would need separate legislation or regulatory action); after 2019 offers of coverage would be reported via W-2
- Subject to certain requirements, states could opt out of essential health benefits, aspects of community rating and age banding requirements
- Most recent amendment provides additional $8B to help states pay for pre-existing condition claims
The Congressional Budget Office has not scored the version of the bill passed by the House. Earlier, they projected the number of uninsured would increase by 14M in 2018, 21M in 2020 and then 24M in 2026 relative to projections under the ACA. CBO has not released revised numbers to reflect the most recent changes. The combination of more people without coverage and cuts in Medicaid funding could potentially result in cost shifting to employer-sponsored plans. Another concern is that employers may have less ability to transition certain populations (early retirees, part-time employees) to individual coverage as a design option.
Important context of this bill in the process of becoming a law
The bill faces significant hurdles in the Senate. The Senate requirements for what qualifies for reconciliation legislation are expected to result in some trimming of provisions that don’t have an impact on the federal budget, and GOP senators will want to make other changes, including more generous tax credits and more time to unwind the ACA’s Medicaid expansion. A Senate-passed bill may be difficult to pass again in a conservative House – both chambers will need to agree on the final version before it can be sent to President Trump.
We will continue to track and provide updates.
Check out this article for tips on managing out-of-pocket expenses in a high-deductible health plan. Typically, your paycheck deductions are lower, which is a bonus, but how do you keep from falling behind financially when you need care? Here are the author’s suggestions, plus a few from me.
- Take advantage of preventive services covered at 100%. For example, get a flu shot so you are less likely to get sick.
- Use in-network providers for the lowest possible out-of-pocket expense.
- Consult with a nurse for free by calling the nurse-line for a consultation before scheduling an appointment with a physician; it could save you the cost of an office visit
- Many plans include a telemedicine benefit. The cost of a telemedicine visit is usually around $40-$50, and can be scheduled at your convenience via phone or video chat.
- Investigate "convenience care” clinics in your area. Located in stores like Target, CVS, and Walgreens, they offer a limited number of services at a lower cost than urgent care or a physician office visit.
- When your doctor recommends a prescription drug, ask how much it costs and if there is an over-the-counter or generic option. Check a few different pharmacies for the best price.
- If a prescribed drug is very expensive and you have not used it before, ask whether you could have a smaller number of pills at first to be sure it works. Check to see if there are patient assistance programs to help defray the cost.
- Shop around for services and tests. A variety of tools exist to support comparison shopping; check with your insurance company for help.
- Some employers offer indemnity coverage -- policies that will pay a set dollar amount when you have an accident or are hospitalized. These low-cost coverages can provide peace of mind for those concerned about covering expenses before they meet their health plan’s high deductible.
- If you’ve moved to the high-deductible plan from a more expensive plan, take the savings from lower paycheck deductions and deposit them (tax-free!) in a health savings account. That way you will have some money set aside to help pay for care before you meet the deductible. Many employers will help fund your HSA.
- Take advantage of any opportunities to earn dollars for your HSA by participating in healthy activities like biometric screenings.
These are good suggestions to communicate to employees and their families. Even if you have provided similar guidance in the past, everyone can always use a refresher.
House Republican leaders are working to win the votes needed to pass a revised version of their health care reform bill, the American Health Care Act (AHCA), that aims to lower health insurance premiums for some individuals by letting states obtain waivers to opt out of the Affordable Care Act's (ACA) essential health benefits, community rating, and age banding requirements.
The latest revisions reflect negotiations between leaders of the conservative House Freedom Caucus and the moderate "Tuesday Group" since the March collapse of Republicans' first attempt to pass the bill, which Speaker Paul Ryan, R-WI, pulled from floor consideration because it lacked support. Other changes to the AHCA since its introduction include the addition of a risk-sharing program to help insurers cover high-claims costs.
These latest revisions brought an official endorsement from the Freedom Caucus, and GOP leaders had hoped to rush the bill to a floor vote this week before the 100th day of President Donald Trump’s presidency on Saturday. But many moderates, leery of what they see as a lessening of consumer protections by the new changes, are not rushing to sign on to the bill, and some have announced opposition. Leaders are trying to secure enough support to pass the bill the first week of May, but the outlook is uncertain.