House Republicans made several changes to the American Health Care Act (AHCA) in an effort to garner support from GOP holdouts who could prevent its passage.

Democrats have been vocal in their opposition to the bill that would repeal and replace the Affordable Care Act (ACA), saying it would cause too many people to lose insurance coverage and raise costs for those who can least afford it.

But GOP members of the conservative House Freedom Caucus have also opposed the bill, saying it does not go far enough in rolling back the ACA’s tax subsidies. Republican Party leaders on Monday submitted a manager’s amendment aimed at gaining votes from that bloc. Among the changes:

  • The measure would repeal most of the ACA’s taxes at the end of 2017 instead of the end of 2018.
  • States would be allowed to require nondisabled, nonelderly, non-pregnant-adult Medicaid recipients to work.
  • The amendment would prevent non-Medicaid expansion states from expanding by denying enhanced Federal Medical Assistance Percentage (FMAP) funding for the expanded coverage population. (In Medicaid expansion states, beneficiaries who enroll in the expansion prior to Dec. 31, 2019, would be grandfathered into the program.)
  • The revised bill would allow states to opt to receive federal Medicaid funding as a block grant for adults and children instead of a per capita cap system.

The non-partisan Congressional Budget Office (CBO) has said the AHCA, in its original form, would cause 24 million people to lose health insurance within a decade but reduce federal deficits by $337 billion. The CBO is now expected to issue an updated analysis of the new version prior to a full House vote.

The House Rules Committee took up the bill on Wednesday. The legislation was expected could go to a vote by the full House on Thursday, but Republican leaders delayed the vote.

The American Hospital Association (AHA), LeadingAge and SDAHO oppose the bill.