What’s Really In the American Healthcare Act (AHCA)


The American Healthcare Act (AHCA) has narrowly passed the House and is on its way to the Senate where it will be rewritten. It has flaws but at least it’s off the ground.

The House specifically did not exempt themselves from the law.

The Mandates Are Gone

The GOP plan eliminates the individual mandate requiring every person to carry insurance or face fines, and also deep-sixes the employer mandate which forced employers with at least 50 employees to provide healthcare coverage. Some employers reduced the hours of employees due to the costs of insurance.

To encourage people to buy and maintain coverage, insurers are prohibited from ending insurance plans or raising premiums of people who hold continuous coverage.


The subsidy system is replaced beginning 2020. Taking its place is an age-adjusted, advanceable, refundable” tax credit for individuals and households, raging from $2,000 to $14,000 per year (with generosity levels phasing out for wealthier recipients). Insurance companies can offer younger consumers cheaper plans.

The tax-free annual contribution to Health Savings Accounts doubles.

My doctor told me that people will pay for any luxury item but they don’t want to pay for their medical care. It’s sad but true. What this plan does with Health Savings Accounts is it puts some of the responsibility back on to the insured. Obamacare puts all the responsibility on the federal government which tends to use taxpayers as ATMs. It’s a better message. People need to have a sense of personal responsibility.

Tax Credits

ObamaCare’s income-based tax credit program is now one based on age. Credits range from $2,000 to $4,000 for the over 60.

It’s still an entitlement but less so.

The Pre-Existing Conditions Fiasco

This has ultimately transformed health insurance into an entitlement but it is what most Americans want. Aetna CEO Mark Bernstein reports that less than 5 percent of Obamacare enrollees consume half of the healthcare. The burden for those costs was placed on healthy buyers raising premiums to double or more in some cases. The chronically ill paid the same price as the healthy under Obamacare – community pricing. People didn’t sign up because it’s unfair.

The AHCA keeps protections for those with pre-existing conditions but states are allowed to waive out of Obama regulations. In place of that, everyone puts into the pot, not simply the young and healthy. There are layers of protections for those requiring extensive care. The bill provides $130 billion a year for their care and it should be adequate.


Those already included in the Medicaid expansion are grandfathered in as federal healthcare transitions to a state-focued plan. States can opt for block grants.

It gives states more flexibility and more freedom from the feds.

It’s also more honest. States like New York, New Jersey, and California are wanton in their healthcare service as politicians use the benefits to get re-elected. They will be more noticeably responsible and won’t be able to hide behind the federal government.

Elizabeth Warren sees her high-tax state losing. She uses the opiod crisis which every state is facing and which is due in part to her open border policies.


Almost all Obamacare taxes are gone. Those artificial limbs and critical drugs will no longer be taxed. View the repealed taxes.


The plan needs to do a better job of protecting older Americans who will be priced out of affordable plans. The tax credits won’t be enough. Senator Than plans to address this.

Also, there are concerns about keeping people on insurance so they don’t buy it only when they need it. The Senate is planning to work on that as well.

What Happens Now

The Senate plans to use the House bill, pull out those features that can stand and then they will engage – hopefully.

Democrats would not participate in the process although they know Obamacare has failed. Instead, they offered chants when it passed. “Na Na Na Na, Hey Hey Hey, Goodbye” they sang, reminding me of my elementary school days.

Bernie is out spreading misinformation. He will accept nothing less than universal healthcare.

Warren says people will die. Eventually we all will but that’s where her facts end.

Don’t forget what the Democrats gave us.

If you want to keep your doctor, you can keep your doctor.

You will save $2500 in premiums.

You have to pass the bill before you can see what’s in it “away from the fog of the controversy”.


Last Thoughts

Many Americans have bought into the notion that healthcare is an entitlement and it makes it difficult, if not impossible, to fully repeal Obamacare in the minds of many Republicans.

This plan shares responsibility with the consumer whereas Obamacare put it completely in the hands of the federal government and, thus, the U.S. taxpayer. Under Obamacare, only those tax-paying producers the government singled out were held responsible with carve outs for allies. All that has changed.

Unfortunately, because Republicans are now on record as saying they are going forward with nationalized healthcare, there is a danger that it will be transformed into single payer as Democrats criticize every item the new plan doesn’t pay for,  as Americans demand more, and as Republicans cave.

The problem of changed expectations among the American public who now see healthcare as an entitlement will remain with us thanks to a Democrat Party that has moved into the far-left and Republicans who have altered their platform.

Charles Krauthammer paints a bleak picture and says that the Republicans are no longer arguing for a free market based system and “in less than seven years we will be in a single payer system”. If he is correct, kiss America as we knew it goodbye.

Republicans say this will not happen – they are trying to drive private markets and find plans everyone can buy into.