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Amid Political Semantics, Amodei Analyzes the American Health Care Act

May 4, 2017
Press Release

FOR IMMEDIATE RELEASE                                                Contact: Logan Ramsey, 202-225-6155

WASHINGTON, D.C. – Congressman Mark Amodei (NV-02) today released the following statement in regards to H.R. 1628, the American Health Care Act (AHCA):

“Since the convening of the 115th Congress four months ago, my office has been conducting extensive research into the various AHCA proposed reforms.

“The notions that healthcare in general, and the seven-year-old Affordable Care Act in particular, needed further legislative action, are in my opinion – valid.

“With Speaker Paul Ryan’s proposal – the AHCA – introduced several months ago, my primary focus in evaluating that proposal was, and remains, the impacts on Nevada’s second largest insurance group – those on Medicaid (21%).

“When speaking on the Medicaid issue, I break Nevadans on Medicaid into two groups. Those on traditional Medicaid: children, pregnant women, disabled, and the elderly.  And those Nevada Medicaid enrollees whose eligibility was established through Medicaid expansion and by the Affordable Care Act.

“I am happy to indicate to Nevada traditional Medicaid enrollees, that my review of the current version of the AHCA will make no changes in current enrollee eligibility and will likely increase federal funding to Nevada’s traditional Medicaid program based on Nevada’s historical per capita growth rate, versus the growth rate provided in the bill.

“With respect to Nevada’s expanded Medicaid enrollees, my overriding concern was that the AHCA would leave Nevada with a nearly $245 million shortfall by cutting federal Medicaid funding to the states over the coming four years. So long as that potential deficit was a possibility for Nevada – I was a “no” vote. The prospect of either kicking Nevada Medicaid expansion enrollees off of Medicaid, or forcing the 2019 Legislature to make up a nearly quarter of a billion dollar loss in federal Medicaid funding was, and is not, acceptable to me.

“As a result of extensive discussions, further research, and the involvement of present and former Nevada Medicaid officials, Secretary Tom Price of the U.S. Department of Health and Human Services, Administrator Seema Verma of the Centers for Medicare and Medicaid Services, Vice President Mike Pence, and the House Republican Leadership – I have identified language in the present version of H.R. 1628 which establishes the following facts:

1.  “Any Nevadan who has enrolled in the expanded Medicaid program from its inception in 2014 through the end of 2019 is free to remain in the program so long as their income does not exceed 138% of the national poverty level. This is current law under the Affordable Care Act;

2.  “Nevada will continue to receive enhanced federal Medicaid funding for enrollees that it is currently receiving for as long as that enrollee stays in that program;

3.  “Present expanded enrollees lose eligibility only if they exceed income of 138% of the national poverty level, or if they elect to take employer provided or private health insurance;

4.  “Included in the bill are tax credits paid in advance (available even if the individual doesn’t owe taxes) and additional cost-sharing mechanisms to ensure those recently leaving Medicaid can have access to insurance on the private market;  

5.  “These conclusions are based on the language contained in the bill, which you may find below.

“Accordingly, I have concluded that the potential for Nevada deficits or expanded Medicaid enrollees being kicked off of Medicaid will be avoided. While I know anything to do with American healthcare is incredibly controversial, we need to continue the process of improving healthcare in America. I fully expect the Senate to continue what has been a raucous discussion to say the least. Nevertheless, American healthcare badly needs work. With my vote today, I am supporting a start of that newest work chapter, while attempting to protect Nevadan’s healthcare interests.”




Expansion ACA v. AHCA

1. As amended by the ACA, Section 1905(y)(1) of the Social Security Act lists the FMAP rates for the ACA Expansion population:

(y)Increased FMAP for Medical Assistance for Newly Eligible Mandatory Individuals.—

(1) Amount of increase.—Notwithstanding subsection (b), the Federal medical assistance percentage for a State that is one of the 50 States or the District of Columbia, with respect to amounts expended by such State for medical assistance for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i), shall be equal to—

(A) 100 percent for calendar quarters in 2014, 2015, and 2016;

(B) 95 percent for calendar quarters in 2017;

(C) 94 percent for calendar quarters in 2018;

(D) 93 percent for calendar quarters in 2019; and 90 percent for calendar quarters in 2020 and each year thereafter.

(E) 90 percent for calendar quarters in 2020 and each year thereafter.

2.   AHCA Section 112(b) modifies this section such that this rate only applies to individuals enrolled before 12/31/219 who do not have a break in eligibility for more than one month:

Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended— (1) in subsection (y)(1), in the matter preceding subparagraph (A), by striking ‘‘with respect to’’ and all that follows through ‘‘shall be’’ and inserting “with respect to amounts expended before January 1, 2020, by such State for medical assistance for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i) who are enrolled under the State plan (or a waiver of the plan) before such date and with respect to amounts expended after such date by such State for medical assistance for individuals described in such subclause who were enrolled under such plan (or waiver of such plan) as of December 31, 2019, and who do not have a break in eligibility for medical assistance under such State plan (or waiver) for more than one month after such date, shall be…”