23 Jun Better Care Reconciliation Act: What You Need to Know
At long last, yesterday we all received the first look at the healthcare bill that is the product of the legislative process following the House’s passage of the American Health Care Act (AHCA). The Better Care Reconciliation Act (BCRA) is the bill born from the Senate – specifically, thirteen senators who worked on the legislation. Senate Majority Leader Mitch McConnell has expressed an interest in putting the bill up for vote next week, before the nearing 4th of July break. As stated in the Health Affairs Blog, the Senate bill has the same number as the House bill, but effectively strikes the House bill, replacing it with the Senate bill.
Health Affairs conducted a very thorough comparison of the two bills. They found that some provisions in both bills are nearly identical, including:
- A year-long exclusion of Planned Parenthood
- Elimination of state enrollment streamlining options
- Elimination of retroactive eligibility
- A state option to impose work requirements
- Both contain Medicaid block grant options, but the Senate bill differs in structure and eligible population
Modern Healthcare also provided a comparison that took the current law into account, in addition to comparing the AHCA and the BCRA. They found that the BCRA, in comparison to the Patient Protection and Affordable Care Act (ACA), would mean the following changes (not inclusive of all potential changes):
- With regard to Medicaid, the BCRA “would exclude disabled children, breast and cervical cancer patients and children covered under the Children’s Health Insurance Program from the Medicaid cap formula. Experts say, however, that it would be difficult or impossible to protect any beneficiaries from the effects of the per capita cap structure, because states would receive fixed federal payments and have to make tough choices about cutting eligibility, benefits and payments to providers.”
- The BCRA would eliminate the individual mandate to purchase insurance or face a penalty
- The BCRA would facilitate a way for states to apply for waivers to essential health benefits – ten items identified by the ACA legislation required of all insurance. Unlike the House bill, the waivers would not permit rejection of high-risk applicants or enable insurers to charge these applicants more for coverage
- Some taxes instituted by the ACA as a means of funding components of the law would be repealed, some retroactively. The Cadillac Tax, a tax instituted by the ACA on insurers offering plans exceeding a determined value, would be temporarily repealed, scheduled to return in 2026.
- The BCRA would phase out the ACA’s enhanced federal payments to states participating in Medicaid expansion by 2023. Modern Healthcare suggests this would likely prompt most of the 31 states participating in expansion to term coverage for the expansion population.
The Congressional Budget Office (CBO) is expected to issue its estimate of the cost and coverage of the BCRA sometime next week.