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Delay of the Medicare Tax Increase 

The repeal of Medicare payroll tax on high income employee wages has been postponed until 2023.

Patient and State Stability Fund

As we have discussed previously, the AHCA establishes the Patient and State Stability Fund to be used by states to provide financial assistance to hi-risk consumers, stabilize and reduce individual market insurance premiums, promote participation in the individual insurance market, promote preventive care, or reduce out-of-pocket costs.

This amendment adds maternity and newborn care to the permissible ways states may use this funding. This amendment also increases funding for this fund by $15 billion and provides that this funding must be used by states for maternity coverage/newborn care and mental health/substance use disorders. 

Essential Health Benefits

Under the ACA, all plans must cover the same categories of medical treatment, called Essential Health Benefits. These categories are currently decided by the federal government and include the following: 
  • Ambulatory patient services 
  • Emergency services
  • Hospitalization
  • Pregnancy, maternity, and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitative and habilitative services
  • Laboratory services
  • Preventive and wellness services
  • Pediatric services, including dental services

The amendment specifies that each state will determine what essential benefit categories must be covered by plans sold in the state.