This blog was last updated on June 26, 2021

Congressman Tom MacArthur has authored an amendment to the American Health Care Act (AHCA) that would provide greater flexibility to states by allowing them to request waivers from any of three key AHCA provisions:

• The 5:1 Age Rating Ratio: The age rating ratio, which is already being increased from 3:1 to 5:1, will be subject to further increases by states that obtain waivers beginning in 2018.
• Essential Health Benefits: The federal government will permit states with waivers to require coverage of fewer essential health benefits than those defined by federal standards beginning in 2020.
• The Continuous Coverage Requirement: States will be permitted to obtain a waiver from the “Continuous Coverage Requirement” and replace it with health status rating and underwriting of insurance policies starting in 2019. Each state must operate a risk mitigation plan or participate in the Federal Invisible Risk Sharing Program to maintain an active waiver.

The Department of Health and Human Services would approve all waivers within 60 days of a state’s application, and each waiver will have a validity period of up to 10 years provided the state maintains a risk-sharing program for the duration.

The Amendment also indicates there are certain provisions from which a state may not obtain a waiver. For example, a state may not obtain a waiver from the law’s prohibitions on gender discrimination, and a state may not allow any denials of coverage based on a patient’s preexisting condition. That being said, a state may still allow insurers to charge higher premiums for preexisting conditions based on the health status rating option.