Following an unfavorable review by the Congressional Budget Office (CBO), Senate GOP leaders on Thursday issued a revised version of the Senate healthcare bill. The revised Better Care Reconciliation Act (BCRA) includes new provisions aimed at winning the support of wavering Senators on the right and in the center. The following revisions were added to the original bill:
Changes to Medicaid
The original bill proposed substantially changing Medicaid financing by placing a cap on the growth rate of per-beneficiary spending. The CBO anticipated that this shift would reduce federal funding for Medicaid by $772 billion over 10 years and reduce Medicaid enrollment by 14 million by 2026. The revised bill still contains the Medicaid spending cap; however, the new bill would also:
- Allow states to apply for waivers from spending limits on programs that improve community and home-care services for the elderly and individuals with disabilities;
- Not count assistance spending during public health emergencies towards the per capita spending caps, and;
- Grant states the ability to cover Medicaid expansion through block grants.
Changes to the Individual and Employer Health Insurance Markets
The original bill contains health insurance market rules that were established through the Affordable Care Act (ACA), including prohibitions against charging higher premiums to individuals based on health status and turning down individuals based on pre-existing conditions. Plans must also cover essential health benefits and limit the annual out-of-pocket cost sharing that individuals must pay. The revised bill amends these requirements by allowing an insurer to sell exchange coverage that does not meet ACA requirements as long as the insurer offers at least three ACA-compliant plans. In addition to these changes, the revised bill would also:
- Provide $70 billion in funding to insurers to cover high-risk exchange patients;
- Provide tax credits to individuals covered through catastrophic plans;
- Allow individuals to use Health Savings Accounts to pay their premiums ; and
- Provide $182 billion for innovations aimed at reducing out-of-pocket costs and premiums.
The revised bill also dedicates $45 billion (up from $2 billion) to fighting the opioid misuse epidemic and does not repeal ACA taxes on Medicare Health Insurance, net investment income, or executive compensation for particular health insurance executives. The bill is scheduled for a floor vote next week.