The bill is scheduled for a floor vote next week, but it’s not clear if this latest version of the Better Care Reconciliation Act of 2017 has enough support to pass the Senate. It will require near-unanimous support from Republicans because no Democrats support it.
Senate Republicans on Thursday unveiled their revised plan to repeal and replace the Affordable Care Act that now scraps a tax cut for the wealthy, increases subsidies for individual coverage, drops the individual mandate and allows insurers to offer no-frills plans.
The revised bill retains a contentious provision for a per capita cap on Medicaid spending and a decade-long phase out of the ACA’s Medicaid expansion that could mean a loss of coverage for millions of people.
The bill is scheduled for a floor vote next week, but it’s not clear if the latest version of the Better Care Reconciliation Act of 2017 has enough support to pass the Senate. It will require near-unanimous support from the majority 52 Republicans because no Democrats support it.
Republican Sens. Rand Paul of Kentucky and Susan Collins of Maine have already said they will not support the BCRA for completely different reasons. Paul says the BCRA remains too much like Obamacare, which he had pledged to repeal. Collins said she can’t support the Medicaid cuts.
The nonpartisan Congressional Budget Office has yet to score the latest proposal, and it’s not clear if the actuaries will be able to do so before next week’s planned floor vote.
In an effort to address criticism that their plan is primarily a tax cut for the rich while slashing services for the poor, the Republicans’ revision scuttled a plan to eliminate Obamacare’s 3.8% tax on investment income and a 0.9% surtax for Medicare, both of which target high earners with incomes in excess of $200,000. Some smaller taxes were eliminated, such as the tax on tanning salons.
The new bill also includes a modification of a provision pushed by Sen. Ted Cruz, R-TX, that would allow health insurers to offer bare-bones, discount policies that don’t comply with minimum coverage mandates under the ACA for mental health services, maternity and pediatric care, addiction treatment, prescription drugs and emergency medicine. The bill also provides $70 billion to create a high risk pool to help offset the costs of people with pre-existing conditions who buy the bare-bones plans.
The original BCRA provided $2 billion to help states deal with the opioids abuse crisis. That funding was increased to $45 billion in the revised bill in an effort to gain support from Senators in rural states that have been particularly hard hit by the epidemic.
The revised bill adds another $70 billion to a $112 billion state stability fund that was proposed in the original bill, which is designed to help states create and coordinate programs that lower coverage costs for consumers and insurers.
The new BCRA also includes a provision that allows people to use their tax-exempt health savings accounts to pay for insurance premiums.
John Commins is a senior editor at HealthLeaders.