- Senate Republicans released a revised draft of the Better Care and Reconciliation Act (BCRA) on Thursday, and it does not make fundamental changes from the original version. Most notably, sharp cuts to Medicaid remain in the latest draft.
- The bill does include an amendment from Sen. Ted Cruz (R-Texas) that would allow insurance companies to sell plans that do not meet minimum Affordable Care Act (ACA) requirements so long as they offer at least one plan that does. The insurance industry has opposed this idea, saying it would lead to “widespread adverse selection and unstable health insurance markets."
- Other changes include some new funding: $45 billion to fight the opioid epidemic and $70 billion to help insurers pay for particularly expensive customers. It would also let anyone use premium subsidies to buy catastrophic coverage and use pre-tax dollars to pay premiums.
The latest changes to BCRA are designed more toward swaying a few Republican senators on the fence about the bill than addressing industry concerns about the number of people who would lose coverage and the Medicaid cuts.
The Congressional Budget Office (CBO) estimated the original version would make 15 million people uninsured as soon as next year, and its predictions aren't likely to change much with the new draft. As such, the numerous industry groups opposed to the bill don’t seem to be changing their tune.
The BCRA still phases out Medicaid expansion and then institutes per-capita caps. It also repeals the ACA’s individual and employer mandates, offers lower premium subsidies and gives states more ways to circumvent essential health benefit requirements.
Senate Majority Leader Mitch McConnell has a tough — if not particularly long — road ahead to try and pass the bill. Even with the postponement of Congress’ annual summer break, there is a definite chance the bill won’t get a vote. Senate leaders said they will look for a new CBO score next week and then try to hold the vote as soon as possible.
Cruz is pushing his amendment as being in support of consumer freedom, but policy experts and payers themselves say the resulting segmentation of the market would cause extravagant out-of-pocket costs for people with pre-existing conditions and adverse selection that would damage stability of the individual market.
There is still plenty of room for more changes to the BCRA. The bill must meet strict rules to be passed as part of the budget reconciliation process, which requires only 51 votes, and the Senate parliamentarian has yet to rule on whether all of the bill's provisions qualify. Other changes could target individual senators who are withholding approval.