Senate’s second attempt at fixing BCRA still leaves 22 million more people without health insurance 


July 21, 2017

The Senate published more amendments to their Obamacare replacement plan – the Better Care Reconciliation Act (BCRA) – yesterday, July 20th, and later that day the CBO announced that it was only as good as their original draft, which still left 22 million more Americans uninsured by 2026 than if Obamacare remained in place.

This second amended bill removed the Cruz Amendment, which would allow carriers to offer plans in the marketplace that didn’t cover pre-existing conditions so long as they also offered a least one plan that did cover pre-existing conditions.

It also reasserted that if a person went without creditable coverage for a continuous 63 days, they would be prohibited from enrolling for another 6 months on top of that all. Also, if a person went without coverage for 63 continuous days but then experienced a Special Enrollment Period or an Open Enrollment Period, they could submit their application for insurance coverage, but the coverage wouldn’t start for another 6 months.

This amendment also changed the tax credit system a little bit, which would go into affect in 2020 (people would still get subsidies under Obamacare until then). If a person received more tax credits (or subsidies if before 2020) than they should have because they underestimated their income, that would have to pay the difference back in full. Also, people who earned up to 350% of the federal poverty level could receive tax credits. Finally, the tax credit system would consider a combination of the person’s income and age. A person who earns less than 150% of the FPL will get a certain tax credit, no matter what their age, but a person who earns 150% of the FPL or more will get more tax help if they are younger than if they are older. Therefore, a person who is older and earns more than 150% of the FPL will get less tax credits to pay for their premiums than a person who is younger and earns the same amount of money. Finally, people can use tax credits to pay for catastrophic plans, which was prohibited under Obamacare.

Also amended in this version of the BCRA is the individual and employer mandates under Obamacare, which will be retroactively repealed to 2016, the small business tax credit will go away starting in 2020, and the Cadillac Tax on high-cost employer plan will be put on hold until 2026.

There are also a number of changes made to Health Savings Accounts including that they can be used to pay for the premiums of high deductible health plans and over-the-counter medications.

The BCRA will also roll back Medicaid funding and will move to a per-capita model. It will also allow states to expand eligibility starting in 2020 but will not allow non-elderly individuals earning between 133% and 138% of the FPL to be on the program. States would also be allowed to re-determine eligibility of a recipient every 6 months and can impose a work requirement.

The benchmark plan percentage to determine tax credits will go down from 70% under Obamacare to 58% under Trumpcare and the age ratio to determine premium rates will go from 3:1 under Obamacare to 5:1 under Trumpcare, but states can choose to impose different ratios if they want.

This isn’t a solution, and we’re anticipating that this comes to a grinding halt very soon, with support not coming from Democrats or the majority of Republicans. Without question, this is “to be continued”…