On Thursday, the Senate released a draft of its plan to repeal and replace the Affordable Care Act. The bill, H.R. 1628—or Better Care Reconciliation Act of 2017 (BCRA)—is similar to the legislation the House passed in May, which eliminates both the ACA’s employer and individual insurance mandates and most of the taxes it levied. Notably, it removes the controversial “continuous coverage” provision that the AHCA used to replace the mandate — although this is likely to change before final passage.
The BCRA phases out Medicaid, although on a longer timeline than the AHCA. It looks to deal with the growing costs of Medicaid by block-granting money to states with a growth rate that is linked to inflation. This hopes to give states more flexibility in adopting programs that work best for their state and increasing efficiency throughout the Medicaid program.
Importantly, the legislation does not include the waiver language from the so-called MacArthur amendment that was instrumental in getting fiscally conservative support to pass AHCA — instead, it looks to reform “1332 waivers” that were already included with Obamacare but rarely used because of the cost and burdens of doing so. Under the plan, there would be money appropriated to ease the financial cost when states seek a waiver, and the burden of proof will shift away from those seeking waivers.
The Congressional Budget Office released their score of the legislation, which they predict leaves about the same amount of people uninsured as the House bill. However, they do provide the caveat that the drop in coverage would be, “primarily because the penalty for not having insurance would be eliminated.” The CBO also estimates that premiums will increase in 2018 by 20 percent and by 10 percent in 2019. The good news comes in 2020, when premiums would be about 30 percent lower than under ObamaCare and 20 percent lower by 2026.
CBO estimates that on net, the bill would cut the deficit by $321 billion over the ten-year window — about $200 billion more than the House bill would — a good bit of these savings are a result of an estimated 15 million fewer people on Medicaid coverage by the year 2026.
Republicans have been working on replacing the Affordable Care Act for over half a decade, and they may be closer now than ever before. However, the pros and cons of this bill — and what the final version will look like — are still very much in dispute, even among the Republican conference. Whether Leader McConnell has the support necessary to move forward on this legislation remains to be seen, but the next weeks will be crucial for the future of American healthcare.