The House on May 4, 2017, approved the American Health Care Act (AHCA), which would repeal much of the Affordable Care Act (ACA); repeal of many tax provisions would be effective in 2017. The vote was 217-213.

The vote was seen as a victory for President Trump, Speaker Paul Ryan (R-WI), and other Republican leaders. They have worked to build support for the measure since cancelling a March 24 House vote on a previous version of the AHCA. President Trump has said resolution of the health care bill should precede action on tax reform.

The AHCA (H.R. 1628) was revised, through an amendment by Rep. Tom MacArthur (R-NJ), to allow states to apply for a waiver through Health and Human Services (HHS) if they establish a high-risk pool to cover individuals with high-cost health conditions. If approved, the state waivers would allow each state to modify the essential health benefits (EHBs) offered as well as to allow for underwriting based on health status and age.

The bill also included an amendment by Rep. Fred Upton (R-MI) to add $8 billion in funding to subsidize coverage costs for people with high-cost conditions who could be affected by health insurance premium or out-of-pocket cost increases as a result of this potential state waiver action. A new Congressional Budget Office estimate of the cost and coverage implications of the revised bill has not been made available.

The AHCA includes nearly $1 trillion in tax cuts over 10 years. Many ACA tax provisions would be repealed effective beginning in 2017, including the 3.8% net investment income tax, the medical device excise tax, the tax on prescription medications and the health insurance tax. Implementation of the Cadillac tax would be delayed until 2026. Repeal of the .9% Medicare surcharge tax on individuals earning over $200,000 annually would be effective beginning in 2023.

The Senate is expected to consider the legislation, although changes are expected. Leader Mitch McConnell (R-KY) has appointed a working group to consider what changes should be adopted in the Senate. Some Republican Senators have expressed concern about the proposed Medicaid changes and the structure of the tax credits in the House bill. Republicans hold 52 seats, meaning they can only lose the votes of two GOP senators to pass health care legislation under reconciliation. House Democrats were outspoken in their opposition to the AHCA, and Senate Democrats are likely to resist efforts to dismantle the ACA.

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