Health Reform Hub: Repeal, Replace, or Repair?

Visit the updated Health Reform Hub here!

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House and Senate Bills, ACA Comparison Chart

A Crosswalk of ACA Provisions with Proposed Language Under the House American Health Care Act and the Senate Better Care Reconciliation Act.
The National Academy for State Health Policy (NASHP) has released an updated chart and accompanying fact sheets that reflect a revision to the Better Care Reconciliation Act (BCRA) eliminating the “Ted Cruz Amendment” which provided funding to create coverage alternatives for high-risk individuals and The Obamacare Repeal Reconciliation Act (ORRA), a bill that would repeal many of the major provisions of the ACA within a two-year period, but does not offer plans to replace those provisions. On July 21, the Senate Parliamentarian ruled several provisions that could be stricken from BCRA under reconciliation rules. This chart has been updated to include those provisions. View the chart here.

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The Senate’s Better Care Reconciliation Act (BCRA) builds on the American Health Care Act (AHCA) but includes some very significant differences. Learn more below.

Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

Below are our latest tools for states regarding the ACA and the AHCA:

House and Senate Bills, ACA Comparison Chart (Updated: July 25, 2017)
On July 21, the Senate Parliamentarian ruled several provisions that could be stricken from BCRA under reconciliation rules. This chart has been updated to include those provisions.

House and Senate Bills, ACA Comparison Chart (July 21, 2017)
This chart summarizes major provisions included in the Senate Better Care Reconciliation Act and provisions included in the most recent version of the American Health Care Act passed by the House on May 4, 2017.
Where States Stand on Medicaid Expansion Decisions (Updated: July 10, 2017)
This map tracks state Medicaid expansion decisions and approaches states are taking for expanding eligibility to 138 percent of the Federal Poverty Level (FPL).
50 State Interactive Tool: Comparison of Estimated Annual Consumer Premiums: Low and High Cost County in State (June 28, 2017)
50 State data interactive that compares estimated annual consumer premiums for marketplace enrollees under the Affordable Care Act and the Better Care Reconciliation Act.
50 State Interactive Tool: Comparison of Estimated Annual Consumer Premiums: In Single County in a State (June 29, 2017)
50 State data interactive that compares estimated annual consumer premiums for marketplace enrollees under the Affordable Care Act and the Better Care Reconciliation Act.

House and Senate Bills, ACA Comparison Chart (June 26, 2017)
This chart summarizes major provisions included in the Senate Better Care Reconciliation Act and provisions included in the most recent version of the American Health Care Act passed by the House on May 4, 2017.
Estimated AHCA and ACA Premiums and Tax Credits by State, Income, Age, and Select Counties (June 8, 2017)
These sheets present estimated premiums and tax credits under current law created by the Affordable Care Act (ACA) and under the American Health Care Act (AHCA), as passed by the House.
County-by-County Premium Variation (June 8, 2017)
The map below illustrates county-by-county premium variation in states for the second-lowest cost silver plan offered through the health insurance marketplaces in 2017.
Health Care is Local: Impact of Income and Geography on Premiums and Premium Support (June 8, 2017)
This issue brief provides an overview of the context and potential impact of changing the health insurance premium tax credit structure from one that factors for age, income, and local premium costs to one that considers only age.
A Crosswalk of ACA Provisions with Proposed Language Under the House American Health Care Act (May 9, 2017)
This chart summarizes major provisions included in the 2010 Patient Protection and Affordable Care Act (ACA) and provisions included in the most recent version of the American Health Care Act passed by the House on May 4, 2017.

An Update on the Three Prongs of Health Reform (March 21, 2017)
This blog and chart explores the notable policy and technical changes to the AHCA, as well other bills working their way through the house that could significantly alter state regulatory authority over certain insurance products.
An Overview of ACA Provisions and Their Repeal Implications for States (January 24, 2017)
With this chart, NASHP provides an overview of ACA provisions and looks at what states would likely need to do to comply if the ACA is repealed.
State Checklist: Medicaid-Related Provisions Impacted by an ACA Repeal (January 31, 2017)
This worksheet identifies key requirements of the ACA that impact state Medicaid and CHIP programs and poses questions for state officials to consider in preparing for actions that may need to be taken upon repeal.

Better Care Reconciliation Act of 2017 – Summary of Implementation (Updated: July 21, 2017)
Timeline of the implementation of the most recent version of the BCRA (2016-2026)
Better Care Reconciliation Act of 2017 – Summary of Funding Provisions (Updated: July 21, 2017)
Summary of funding provisions of the Senate’s updated BCRA
Better Care Reconciliation Act of 2017 – Summary of Implementation (June 26, 2017)
Timeline of the implementation of the BCRA (2016-2026)
Better Care Reconciliation Act of 2017 – Summary of Funding Provisions (June 26, 2017)
Summary of funding provisions of the Senate’s BCRA
AHCA Implementation Timeline (May 9, 2017)
This two page publication breakdowns the tax repeal, medicaid, credit, and other implications of the AHCA through fiscal 2023.
Stability Fund Snapshot (May 9, 2017)
One page summary of the funding provisions of the AHCA, including the Upton Amendment and Stability Fund.
State Waivers Snapshot (May 9, 2017)
One pager summary of State Waivers affecting Health Insurance Markets.
Empowering and Protecting Consumers: ERISA Thwarts State Innovation (February 28, 2017)
This NASHP produced publication looks at why Congress needs to amend the Employee Retirement Income Security Act (ERISA) to assure consumers and payers have the information they need to make health purchasing decisions.
Health Savings Accounts — Lessons from States; Questions for Policymakers (February 14, 2017)
This publication explores another element of possible ACA replacement proposals: health saving accounts (HSAs) and high-deductible health plans (HDHPs).
Selling Health Insurance Across State Lines (February 7, 2017)
This brief puts a state lens on emerging proposals in the ACA repeal and replace debate.

BCRA and the Byrd Rule (July 25, 2017)
On July 21, the Senate Parliamentarian ruled that several provisions of the BCRA, as currently written, were in violation of the Byrd Rule and could be stricken from the bill if requested by a point of order from a member of the Senate. Read more in this blog.
Latest Update on Congressional Health Reform Activity (July 21, 2017)
This blog provides a summary of The Obamacare Repeal Reconciliation Act (ORRA), a bill that would repeal many of the major provisions of the ACA within a two-year period, but does not offer plans to replace those provisions.
Should Maine’s Invisible High Risk Pool Law be the Model to Address Market Stability Nationally? (April 18, 2017)
This blog explores the similarity between Maine’s invisible high risk pool and the proposed AHCA amendment establishing an invisible risk sharing program.
What’s Next for the Individual Market? (March 28, 2017)
This blog from Executive Director Trish Riley discusses the goals of the individual market remaining affordable and stable and an economic imperative for a changing American workforce.
Snapshot: State Leaders talk AHCA (March 14, 2017)
NASHP held a summit with state leaders and this blog categorizes the questions they posed after comparing the AHCA to the ACA.
The Prevention and Public Health Fund – Lessons from States; Questions for Policymakers (March 14, 2017)
A NASHP blog discusses how the American Health Care Act would dismantle the Prevention and Public Health Fund (PPHF).
High Risk Pools Deja Vu – Lessons from States, Questions for Policymakers (January 31, 2017)
This blog post explores high risk pools, which are designed to mitigate the impact of high need, high cost enrollees on the non-group market.
Reflections on Repeal and Replace (January 3, 2017)
Amidst discussion of repealing, delaying, and replacing the ACA, what’s ahead for health reform is uncertain, but may be informed by reflection on what’s gone before; more in this blog post.

What the American Health Care Act Means for States (Updated: May 9, 2017)
A new chart from NASHP shows a side-by-side comparison of major components of the ACA and the AHCA. In addition, NASHP also produced an AHCA Implementation Timeline, a Stability Fund Snapshot, and a State Waivers Snapshot. All of these recent products are housed together in this resource page.
An Update on the Three Prongs of Health Reform (March 21, 2017)
This blog and chart explores the notable policy and technical changes to the AHCA, as well other bills working their way through the house that could significantly alter state regulatory authority over certain insurance products.
Snapshot: State Leaders talk AHCA (March 14, 2017)
NASHP held a summit with state leaders and this blog categorizes the questions they posed after comparing the AHCA to the ACA.
The Prevention and Public Health Fund – Lessons from States; Questions for Policymakers (March 14, 2017)
A NASHP blog discusses how the American Health Care Act would dismantle the Prevention and Public Health Fund (PPHF).
An Overview of ACA Provisions and Their Repeal Implications for States (January 24, 2017)
With this chart, NASHP provides an overview of ACA provisions and looks at what states would likely need to do to comply if the ACA is repealed.