Actuaries Outline Implications of American Health Care Act for Medicaid and the Individual Market

WASHINGTON—The American Academy of Actuaries’ Individual and Small Group Markets Committee and Medicaid Subcommittee provided an actuarial perspective on the American Health Care Act (AHCA) in a letter addressed to leaders in the U.S. House of Representatives and shared with all House and Senate members, and all the nation’s governors, today. The letter focuses on the AHCA’s proposed changes to Medicaid’s funding structure, and the legislation’s potential implications for the sustainability of the individual health insurance market.

“As proposals to repeal or replace provisions of the Affordable Care Act (ACA) are considered, the Academy continues to fulfill its public interest mission by providing objective, technical advice to lawmakers based on actuarial principles,” said Academy Senior Health Fellow Cori Uccello. “The goal of our analysis is to inform the debate over how to improve the affordability and accessibility of health insurance coverage in the United States by providing policymakers with insights on where to focus their efforts.”

The analysis examines the effects on enrollment and on the risk pool of the AHCA’s replacement of the individual mandate with a continuous coverage requirement, and the implications of changing the premium subsidies and eliminating cost-sharing subsidies. It also addresses how the AHCA’s state stability fund could help lower premiums and stabilize the individual market.

Regarding Medicaid, the analysis reviews implications of the AHCA’s approach to per-enrollee caps, the potential effects of discontinuing the ACA’s enhanced Medicaid funding, and the changes states could experience based on the ACHA’s framework for increasing per capita caps over time. A new issue brief from the Academy’s Medicaid Funding Work Group examines in greater detail the sustainability implications of alternative funding designs that incorporate state block grants and/or per capita caps.

Learn more about the Academy’s health policy work at actuary.org.


The American Academy of Actuaries is a 19,000-member professional association whose mission is to serve the public and the U.S. actuarial profession. For more than 50 years, the Academy has assisted public policymakers on all levels by providing leadership, objective expertise, and actuarial advice on risk and financial security issues. The Academy also sets qualification, practice, and professionalism standards for actuaries in the United States.