Gearing up for a hoped-for vote before the July 4th holiday, the U.S. Senate (actually, its Republican leadership) this morning released details about its proposed Better Care Reconciliation Act of 2017 in pursuit of the GOP’s goal to “repeal and replace” the Affordable Care Act (ACA, or Obamacare).
The measure is similar to but more moderate than the previously passed House of Representatives bill, the American Health Care Act (AHCA).
The inclusion of “reconciliation” in the title is reflective of the only route whereby the Republicans can get past a Democrat filibuster to pass the legislation — using their majority role and a process called reconciliation. This means that the Republicans can lose only two votes from their ranks and still be able to pass the measure with Vice-President Mike Pence casting the tie-breaking vote as Senate President.
Here are the key elements of the legislation:
- Repeal the individual mandate that all Americans must buy health insurance or pay a penalty, retroactive to Jan. 1, 2016; likewise, end employer shared responsibility (play or pay)
- Retain the ACA rule that insurers cannot deny coverage to those with pre-existing conditions, or charge them more, but unlike the ACHA, does not allow states to opt out of this
- Give states waiver rights to opt out of many of the benefits required by the Affordable Care Act, like maternity care, emergency services and mental health treatment
- Allow states to set up work requirements for those applying for Medicaid
- Continue the payment of cost-sharing reductions (CSRs) to insurers for at least two years to help lower the cost of policies for low-income individuals
- Change the age rating to 5:1 from the ACA’s 3:1, meaning insurers will be able to charge older adults five times more than young adults
- Provide $15 billion for a “State Stabilization Fund” to help lower the price of premiums and increase health coverage for 2018 and 2019. The fund would also provide $10 billion a year in 2020 and 2021
- Expand the annual contribution limits to Health Savings Accounts (HSAs) from $3,400 to $6,700 for individuals and from $6,650 to $13,300 for families
- Reduce the federal government’s portion of state-managed Medicaid expenses to 57 percent over seven years from the current 90 percent
- Put the entire Medicaid program on a budget, ending the open-ended entitlement that now exists
- Repeal the 3.8 percent tax on net investment income retroactive to Jan. 1, 2017
- Mirror the AHCA’s use of tax credits to help consumers pay for health insurance
- Peg insurance tax credits to income like the ACA does, and not to age as the AHCA does
- Reduce the top income level to qualify for a premium tax credit from 400 to 350 percent of the federal poverty level, starting in 2020 (from about $98,000 annually for a family of four to about $86,000 a year)
- Prohibit those who use tax credits to buy insurance from purchasing plans that fund abortions
- End funding for Planned Parenthood
- Establish a $2 billion fund for states for programs to “support substance use disorder treatment and recovery support services for individuals with mental or substance use disorders”