Brief Analysis: U.S. Senate’s Better Care Reconciliation Act

The United States Senate released its version of a new health care bill on June 22nd. Titled the Better Care Reconciliation Act (BCRA), the bill was met with energized advocacy groups immediately dispelling the measure. Earlier this week Congress’ nonpartisan budget referee, the Congressional Budget Office (CBO), estimated that 22 million people would be without insurance by 2026, 1 million less than the House bill which was passed in early May. Facing defeat in a floor vote, with nearly 8 Republican Senators coming out against the bill, Majority Leader Mitch McConnell (R-KY) delayed the vote until after the 4th of July Recess.

Here is a brief analysis of key provisions of the Senate Bill:

  • Medicaid Funding: The bill, like its House counterpart, vastly rolls back Medicaid expansion and phases out federal funding between 2021 and 2023 and further reductions would begin in 2025. The CBO estimates that Medicaid enrollment would fall by more than 15 million people by 2026. Like the House version, this bill would create a block grant mechanism calculated on a per capita basis. Governor Charlie Baker has expressed concern for this and noted that it could cost Massachusetts billions in federal Medicaid funding and leave nearly 264 thousand residents without insurance. The Governor also estimates that the state could face a $8.2 billion shortfall by 2025.
  • Pre-Existing Conditions: Unlike the House bill, insurance companies would be required to accept all applicants regardless of health status. That said, the bill allows states to ask permission to reduce required coverage of essential health benefits. This could result in massive increases for people who want to purchase a plan with essential health benefits. While the CBO estimates that some will see lower premiums, they will also see fewer benefits.
  • Adults Over 50: The Affordable Care Act (ACA) prevented insurers from charging older people more than 3 times what younger enrollees pay. Under the Senate Plan, insurers can charge five times more than younger people and ACA subsidies to help the lower income and elderly pay for insurance would be drastically lower.

What to watch? Since Congress is going through this process under a budget reconciliation rule, the Senate Bill must only have the same amount of savings on the deficit as the House version. Thus, since the Senate version saves over $320 billion over the next 10 years, and the House version saves approximately $100 billion over ten years, the Senate has roughly $200 billion to spend in order to build support with current ‘no’ vote Senators. Keep an eye on states that rely heavily on Medicaid funding, or states heavily impacted by the opioid epidemic. These are some of the Senators currently opposed to the bill, and Leadership may direct additional funding to their states to bring them to a ‘yes’ vote.

For more information or any questions, please contact Jake Krilovich at jkrilovich@thinkhomecare.org

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