What the American Health Care Act Means for States


AHCA, ACA Comparison Chart
AHCA Implementation Timeline
Stability Fund Snapshot
State Waivers Snapshot


On Thursday, May 4, the House of Representatives passed the American Health Care Act (AHCA), a major step in efforts to repeal and replace the Affordable Care Act (ACA). The AHCA now moves to the U.S. Senate, which has established a special committee to handle the bill. Early reports indicate that states can anticipate a long process as the Senate deliberates changes to the bill.

Before passage, the House added a series of amendments, modifying various components of the bill including:

  • A manager’s amendment asserting technical and policy “fixes” to Medicaid–including flexibility over block grants, work requirements, Medicaid expansion—faster repeal of ACA taxes, and a reduction of the tax threshold for medical expenses.
  • An amendment establishing a $15 billion fund that can be used for an “invisible high risk pool”.
  • An amendment allowing states to waive certain insurance requirements including age rating bands, essential health benefits, and the prohibition on medical underwriting.
  • An amendment establishing a $8 billion fund for states that opt to waive medical underwriting restrictions.

Although the Senate has signaled that it may develop its own bill, States must not lose sight of the significant changes included in the amended AHCA , such as losses of Medicaid funding, major changes to the parameters of Medicaid and insurance affordability programs, and establishment of flexible funding programs for states to support affordability and stability.

To aid in your tracking of the bill, we are pleased to provide several new and updated resources:

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.