AHCA v1.0: What You Need to Know - Spiralight Group Benefits | Results-Driven. Proven-Process.™

AHCA v1.0: What You Need to Know

Well the first version of the GOP answer to ACA has been revealed…let the roller coaster ride begin! Several weeks ago, as we were anticipating the release of the new proposed plan and speculating over what might change, it dawned upon us that, what mattered more was what would likely remain the same.

As we anticipated, despite criticisms from conservative groups that this “version 1.0” of what has been named the American Health Care Act is nothing more than “Obamacare-LITE,” we have seen a greater emphasis on various forms of self-insurance (HSAs, HRAs, etc.).

We reiterate that point up front for the simple reason that so much that has been revealed in the past week about AHCA will likely change (eventually leading us to “AHCA version 2.0”).

That said, there are several helpful points to note regarding the proposed plan (some of which are being cited by some conservative groups as holdovers from ACA). We’ve divided these points into what one would clearly consider changes, and the remaining being what is being proposed to remain from ACA.


The first, and most noted difference, is there is no longer a “mandate” to purchase health insurance. The role of the IRS in policing this policy has already been eliminated, and employers are no longer required to offer insurance in fear of having to pay hefty penalties if they do not.

Catastrophic-only and other types policies will be permitted. Under ACA, insurance had to cover basic care without any exclusions (referred to as “essential health benefits”). Anything less was deemed noncompliant. This may be phased in gradually, but the new law opens the door to policies that only kick in under situations of major illness or injury (and presumably would cost less also).

An eventual reduction in Medicaid. This is another proposed change to phase in–however in 2020 new enrollments in Medicaid will be frozen.

Complete repeal of 2010 taxes. This will include taxes on health insurance premiums, prescription and over-the-counter medications, and medical devices.

PROPOSED TO REMAIN (with Modifications):

Tax credits to buy insurance. Although there is some restructuring to how this will be implemented, including considerations for people in lower-earning categories. The tax credit will be between $2,000 and $14,000 per year “…for low- and middle-income individuals and families who don’t receive insurance through work or a government program.”

Pre-existing Conditions must still be covered. HOWEVER…insurance companies will be permitted to charge higher rates or additional fees for those who had lapsed coverage for two months or more in the previous 12 months.

Adult children and college students can keep their parents’ coverage. As with ACA, these young adults can remain on their parents’ coverage until their 26th birthday.

Interested in Learning More?

Launch a webinar I recently led outlining the key points of how your business is affected by the proposed plan. You’ll get through the immediate take-aways in the first ten minutes, followed up with greater detail for those who would like to dive deeper. Click here for instant access!

About the Author Matt Byrne

Matt Byrne has made a career helping people find affordable health insurance. He is the founder of Spiralight Group Benefits, a Dublin Ohio-based brokerage providing comprehensive insurance, HR consulting and compliance solutions for small- to mid-size businesses. Matt has a Bachelor of Arts degree from Boston University and holds a life and health insurance license. He also serves on the executive board of Columbus chapter of the National Association Health Underwriters. Mr. Byrne is a subject matter expert speaking frequently about Health Care Reform, Employer Health Plans Affordability Programs, Self-Funded Solutions and is frequently quoted in national publications such as the Money Magazine, U.S. News and World Report and The Wall Street Journal. Matt can be reached at (614) 300-1316 (assistant) or https://www.grouphealthohio.com/

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