On Thursday, by a slim margin, the vote of 217-213 was one over the 216 votes needed to pass the bill.

The AHCA includes an amendment that includes $8 billion in spending over 5 years to subsidize high risk pools that could be affected by the “waivers” offered to states who wished to opt out of requirements that insurance companies cover preexisting conditions.

Freedom Caucus members who opposed the first draft of the bill, supported this new bill, crucial to allowing President Trump to make good on his promise to “repeal and replace” Obamacare.  Representatives Fred Upton and Billy Long switched their vote from “no” to “yes” bolstering GOP support for the bill that could not lose more than 22 votes.

The American Health Care Act has had to appeal, not to Democrats, but to GOP members who were split on whether the AHCA repealed too many popular components of Obamacare.

The original AHCA including the following:

1. Eliminate the tax penalties, “individual mandate” and “employer mandate” imposed on those who don’t purchase health insurance for themselves or employees.

2. Tax credits will be based on age rather than income ranging from $2000/year for those younger than 30 to $4,000 a year to those who are older than 60. A family would receive up to $14,000 in tax credits a year. These tax credits would start phasing out when income becomes  $75K individually or $150K as a family. For every $1,000 in earnings above those thresholds, the value of the credit phases down by $100.

3. Allow insurance companies to charge a 30% surcharge to those who have gaps in insurance longer than 63 days.

4. Maintain coverage, preventing denial, to those with pre-existing conditions

5. Maintain coverage for children under age 26 who wish to stay on their parent’s plans.

6. Maintaining the bans on caps on annual or lifetime coverage

7. By 2020, ACA promised federal funds for Medicaid expansion will stop.  Funds will continue for current Medicaid recipients

8. Create a Patient and State Stability Fund, which provides states $100 billion to use as they wish for their underserved populations, hospitals, providers or programs that would provide direct care.

9. States will receive money for Medicaid in a lump sum per person rather than an open-ended promise of funds.

10. Taxes on medical device industry will expire as will those on pharmaceutical companies and indoor tanning services.

11. Planned Parenthood is “defunded” as AHCA funds cannot be used to pay for services at their clinics.

12. HRA increase – starting in 2018 individuals could contribute pretax dollars to their Health Savings Account up to $6550 individually and families up to $13,100.

The bill is being analyzed by the Congressional Budget Office (CBO) and will need to be approved by the Senate to move forward.

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Daliah Wachs, MD, FAAFP is a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00am-2:00pm and Saturday from Noon-1:00pm (Central) at GCN.