As indicated in the July 11th Member Alert, AAMS opposes two provisions of the “21st Century Aviation Innovation, Reform, and Reauthorization Act” (H.R. 2997), which will be voted on in the House of Representatives this week:


  • ATC Privatization: While there are numerous provisions in the House bill that AAMS supports, such as provisions to expedite the equipment installation and certification process, AAMS joins multiple general aviation organizations, including HAI, GAMA, NBAA, AOPA, and NATA in opposing the privatization of the ATC.
  • Air Medical Billing Regulations: AAMS and HAI also oppose Section 512 of the bill, which would require the separation of air medical service billing into aviation and “non-aviation” related services. The Provision: (1) Mandates a far-reaching, open-ended, burdensome, and duplicative new regulatory regime; (2) Would pierce the Airline Deregulation Act’s (ADA) preemption provision, inhibiting the delivery of life saving emergency transportation services across state lines; (3) Does not have the benefit of the report and findings of the pending AAMS-supported Government Accountability Office (GAO) study on air medical cost, billing, and reimbursement issues; and (4) Introduces the concept of separating the charges of an air carrier into what could and could not be regulated by states.

Health Care Developments

On July 13, Senate Republicans published an updated draft of the “Better Care Reconciliation Act”, a substitute amendment to the House-passed “American Health Care Act” which repeals and replaces the Affordable Care Act (ACA). The Congressional Budget Office (CBO) is expected to release its updated score next week in advance of the Senate’s anticipated procedural vote on the bill.

Senate Republicans can only afford to lose two votes in order to pass the legislation. Already Senators Rand Paul (R-KY) and Susan Collins (R-ME) have said they will vote against the bill. Senator Ted Cruz (R-TX) stated he is in favor of this draft, but cautioned “if it’s amended and we lose the protections that lower premiums my view could well change.” Other Senators who opposed the previous draft have yet to take a public stance on this new version.

The updated draft:

  • Adds an additional $70 billion to states for the stability funds which can be used to help reduce premiums. This is in addition to the $112 billion provided in the original bill.
  • Does not contain any changes from current law to the net investment income tax, the additional Medicare Health Insurance Tax, or the remuneration tax on executive compensation for certain health insurance executives.
  • Includes an additional $45 billion dedicated to substance abuse treatment and recovery to address the opioid epidemic.
  • Would make individuals enrolled in catastrophic plans eligible for the tax credit so long as other eligibility requirements are met. Individuals would also be able to use health savings accounts to pay for premiums in excess of any tax benefit they already receive.
  • Would allow anyone in the individual market to purchase a lower premium plan, including with federal tax credit assistance. These higher deductible plans would cover three primary care visits per year as well as federal protections in place that limit an individual’s out-of-pock costs.
  • Revises some of the bill’s Medicaid provisions:
    • The Disproportionate Share Hospital (DSH) calculation would change from per-Medicaid enrollee to per-uninsured.
    • States may apply for a waiver for the purpose of continuing and/or improving home and community-based services for aged, blind, and disabled populations.
    • Should a public health emergency be declared, state medical assistance expenditures in a particular part of a state will not be counted toward per capita caps or block grant allocations for the period of the declared emergency.
    • States will have an expanded block grant option to allow them the option of adding the expansion population under the block grant.
  • The draft would create a fund for making payment to specified health insurance issuers for the associated costs of covering high risk individuals enrolled in qualified health plans through the exchange. In order to qualify for this funding, the issuer must offer sufficient minimum coverage on the exchange that remains subject to the ACA’s Title I mandates. This would enable the issuer to also offer coverage off the exchange that would be exempt from the mandates. This provision is a version of the amendment proposed by Cruz and Senator Mike Lee (R-UT).

The full text of the draft bill is available here. Section-by-section summaries are available here (Titles I and II) and here (Title III).