Health Reform Bill Revised in Senate

On July 13, Senate leadership released a revised version of the Better Care Reconciliation Act of 2017 (BCRA), legislation that would repeal and replace provisions of the Affordable Care Act (ACA). While retaining most of the key features of the original version, including a repeal of the individual and employer mandates and significant changes to Medicaid, the revised draft includes additional funding to encourage states to lower premium costs for low-income individuals and a provision that would allow insurers to sell less-comprehensive, lower-cost insurance plans as long as they continue to offer at least one comprehensive option. An analysis of the new draft from the Congressional Budget Office is expected to be released early next week. Senate Majority Leader Mitch McConnell (R-KY) announced his plan to move forward with votes on the measure next week. The situation remains fluid, as negotiations are ongoing.

Health reform legislation titled, Better Care Reconciliation Act of 2017, was released in the Senate on June 22 with the intention to repeal and replace provisions of the Affordable Care Act (ACA). In addition to a repeal of the tax policies of the ACA, the bill proposes significant structural changes to the Medicaid program, including a phase out of federal funding for the Medicaid expansion enacted through ACA, which provides coverage for roughly 11 million people in 31 states.

The Senate’s draft legislation represents a continuation of the process that began when the House passed its own health reform bill, the American Health Care Act, last month. ACC expressed opposition to the House legislation when it became clear the bill did not align with ACC’s Principles for Health Reform. The College will continue to review the bill and monitor the ongoing negotiations in the coming days. Under the budget reconciliation process being used to advance the legislation, 51 votes are required for passage. It is unclear at this time if sufficient support exists among Republican senators. The situation remains fluid; further changes to the bill and the timeline for a Senate vote are possible.

Provisions included in the discussion draft:

  • Payers would be required to cover pre-existing conditions and charge the same rates, with few exceptions. However, states would be allowed to waive other insurance requirements, including rules regarding benefits that payers must cover. Coverage would be guaranteed for children with medically complex disabilities.
  • Premium subsidies currently available under the ACA for people between the poverty level and four times that threshold would be continued for two years. Eligibility would be scaled back slightly to 350 percent of the federal poverty level and extended to more low-income people who don't qualify for Medicaid after two years.
  • Cost-sharing subsidies that help insurers pay medical bills for low-income customers would continue for two years.
  • Individual and employer mandates would be eliminated.
  • States would see gradual reductions in the amount of federal funds provided to expand Medicaid beginning in 2021, restoring levels of federal support to preexisting law by 2024. To date, 31 states and Washington, DC, have expanded Medicaid programs under the ACA.
  • States would be allowed to choose between block grant or per-capita support for their Medicaid populations beginning in 2020, with a flexibility in the calculation of the base year. States could also impose a work requirement on non-pregnant, non-disabled, non-elderly individuals receiving Medicaid.
  • A Long-Term State Innovation Fund dedicating $62 billion over eight years, would be established to encourage states to assist high-cost and low-income individuals in purchasing health insurance.
  • Tax-free health savings accounts would be expanded to provide greater flexibility and control over medical costs. The bill would increase contribution limits to help pay for out-of-pocket health costs and over-the-counter medications.
  • Taxes on health insurance, prescription drugs, medical devices and "high-cost" employer-sponsored plans established under the ACA would be repealed.
  • States would have additional flexibility to address the substance abuse and mental health crisis.

The Congressional Budget Office (CBO) has yet to weigh in with its official estimate of the budgetary and health insurance coverage impact, but both the CBO report and further Senate consideration of the measure are expected in the coming week. Should a bill pass the Senate, another vote in the House would be necessary to send the bill to the President's desk.

The ACC's Health Affairs Committee and Advocacy staff are currently reviewing the draft legislation, guided by the College's Principles for Health Reform. The principles prioritize improved coverage for—and access to—efficient, high quality care; protection for individuals with pre-existing conditions; and continued national investment in preventive care, medical research and innovations. Updates will be posted to and included in the Advocate newsletter. Follow @Cardiology on Twitter for Advocacy updates.

Keywords: Budgets, Health Care Costs, Health Care Reform, Insurance Carriers, Insurance Coverage, Insurance, Health, Medicaid, Patient Protection and Affordable Care Act, Preexisting Condition Coverage, Taxes

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