Senate Releases BCRA Amendments

The Senate released proposed amendments to their version of the healthcare bill, Better Care Reconciliation Act (BCRA), on July 13th. These amendments were supposed to incorporate concepts and ideals requested by all sides of Republican Senators. The amendments to the bill are:

1. 1. The BCRA allows insurers to offer plans to the public that don’t meet the requirements of Obamacare, meaning that they don’t cover pre-existing conditions and include the ten essential benefits, so long as they offer one plan to the public that does meet all of the requirements of Obamacare. The BCRA amendment would provide money to the insurers from a fund to help offset the costs of these higher risk individuals who have pre-existing conditions.

This amendment was introduced by Senators Ted Cruz (R-TX) and Mike Lee (R-UT) and has been controversial amongst other members who are concerned that it will not leave enough options for people who have pre-existing conditions or who want a fuller plan with more coverage options. In order to satisfy those concerns, the amendment also includes additional financial assistance for people who do need a plan that covers pre-existing conditions.

Insurers are not entirely behind this amendment because they believe that by essentially creating one set of plans for sick people (Obamacare-compliant plans) and one set that will be attractive to healthy people because they will be cheaper, but have less benefits, it will make the Obamacare plans unaffordable for consumers because the healthy people won’t be buying them as well and insurance carriers will still leave the marketplace.

1. The Medicaid roll back schedule proposed in the original BCRA language remains the same in the amendment, meaning that funding for the program will start to decrease in 2021 until it is restored to pre-Obamacare levels in 2024. Starting in 2020, states can decide whether they want funding for Medicaid based on a block-grant (set amount of money) or per-capita basis (based on number of people) calculation each year and it also allows the states to impose a requirement for people on Medicaid who are not pregnant, disabled or elderly to be employed in order to continue receiving benefits.
2. The Obamacare taxes will remain in place, which will have an effect on the federal deficit.
3. The government will continue to make the cost-sharing reduction payments to the insurers until 2020, which is necessary to help stabilize the market.
4. The individual and employee mandates will be eliminated. The continuous coverage requirement will be in effect in accordance with the first draft of the BCRA.
5. More money is allotted to help cover the out-of-pocket expenses of consumers. BCRA Amendment proposes an additional $70 billion – with a Grand Total of $182 billion – to go to the creation and implementation of reform efforts to bring down cost of premiums and healthcare expenses including towards Health Savings Accounts (HSA).
6. BCRA would allow people to use money in their HSA to pay for their premiums. The benefit of an HSA is that the money is not taxed, meaning that if you take a portion of your paycheck and put it in an HSA, you will not have to pay Social Security, Medicare, Federal or State taxes on that money.
7. BCRA gives an additional $45 billion to the states to combat the opioid crisis. This money would be used for substance abuse treatment and recovery.
8. People who choose to enroll in a catastrophic plan can get tax credits to help pay for the costs of those plans, which was originally prohibited under Obamacare. Catastrophic plans have high deductibles, smaller networks, and less benefits, but are good in case of medical emergencies.
9. In addition, people can use their tax credit to buy lower-premium health insurance plans that have higher deductibles but allow the person to go to the primary care physician three times a year. These types of plans also limit how much a person can spend out-of-pocket a year.