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MacArthur Amendment Waiver Program

Under this waiver program, states would be able to do any of the following if certain assurance are made.
  • States could increase the age rating rules, which under the AHCA allows older adults to be charged no more than five time the premium as younger adults.
  • States could change the current list of essential health benefits and create their own.
  • States could replace the late-enrollment penalty with health status rating if the state also creates and maintains a risk mitigation program to assist sicker consumers.

All requests for waivers would need approval from the Secretary of Health and Human Services and could only be in effect for 10 years. Further, states would need to explain how their proposed plan helps the following:
  • reducing average premiums for health insurance coverage in the State;
  • increasing enrollment in health insurance coverage in the State;
  • stabilizing the market for health insurance coverage in the State;
  • stabilizing premiums for individuals with pre-existing conditions; or
  • increasing the choice of health plans in the State.

Additional Funding for the 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.
The amendment offered by Mr. Upton makes available an addition $8 billion dollars between 2018 and 2023 to states that have received a waiver under the waiver program discussed above. These additional funds are to be used to assist individuals that reside in a state with an approved waiver, have a pre-existing condition, have not maintained continuous coverage, and need to purchase health insurance in the individual market.