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In early May, the House of Representatives passed their version of the American Health Care Act and the Bill moved on to the Senate. The passage of the Bill by the House does not guarantee that it will become law, as it still needs to move through the Senate. However, when a bill is moved to the Senate for consideration, the Senate has the option to vote on the bill as is or make changes beforehand and sending the revised bill, if passed, back to the House for consideration. Before bringing the American Health Care Act to a vote, the Senate has made changes and is looking to vote on the revised Better Care Reconciliation Act. We set out to understand what the new version of the Bill stands to do.

On May 4th, the House of Representatives passed the American Health Care Act of 2017 (read our overview here) to be passed on to the Senate. The Senate revisions of the Bill, known as the Better Care Reconciliation Act (BCRA) of 2017, have recently been released to the public before being put to a vote. The current version was set to be put to a vote prior to the start of the July 4th recess, but some discomfort with the Bill has led to a delay in the vote, which is not yet scheduled, until after the recess. We set out to see how this Bill is changed from the House Version and what it could mean to the American citizen.

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The Senate version of the Bill aligns closely with the House version, with the exception of eligibility requirements; they propose eligibility based on an individual’s income, rather than their age. This aligns with the Affordable Care Act (ACA), which also determined subsidy eligibility based on income. However, the Senate Bill increases the number of restrictions on requirements compared to the ACA.

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The Senate revisions also call for deeper cuts to Medicaid than the House version, but the cuts will be more gradual. Federal funding for the Medicaid expansion under the ACA would phase out between 2021 and 2023, instead of beginning in 2020, and more reductions would start in 2025. Finally, the Senate version would implement a provision allowing states to impose a work requirement on Medicaid recipients. The Medicaid program covers low-income children, pregnant woman, the elderly, and individuals with disabilities. Under the Senate plan, states will be given a fixed amount of funding for each Medicaid recipient rather than open-ended funding from the federal government.

The senate revisions to the house Bill also change how age will affect individual insurance premiums. Under the ACA, insurance companies were not allowed to charge their oldest customers more than three times what their youngest customers pay. The House and Senate versions of the American Health Care Act increase that difference to five times as much for older customers, possibly even more depending on which state they live in.

The Senate version also addresses pre-existing conditions. The Senate version continues the ACA rule restricting insurance companies from denying coverage or charging more to individuals with pre-existing conditions. States would have the option to waive other rules, however, which would weaken aspects designed to protect those with pre-existing conditions. Some aspects that could be affected include the basic benefits package offered to consumers, as well as the minimum payment insures are required to put towards consumer medical bills.

The Congressional Budgetary Office (CBO) has had time to review the Senate revisions and has released their projections accordingly, which are disputed by the White House on grounds of inaccuracy. According to the CBO, 22 million Americans could lose their health insurance over the next 10 years under the Senate Bill, but the budget deficit would be reduced by an estimated 321 billion dollars. The CBO estimates 15 million more Americans would be uninsured as soon as 2018 due to the elimination of the individual mandate. The analysis also predicts that premiums and out-of-pocket expenses will increase for low-income individuals and those nearing retirement, likely forcing many affected to opt out of purchasing insurance. Predictions by the CBO stated that for a typical 64-year-old with an annual income of $26,500, the net premium in 2026 for a mid-level silver plan, after subsidies, would average $6,500 and cover fewer medical costs, compared with $1,700 under the ACA. A person of the same age with an annual income of $56,800 would see the cost of their premiums triple when compared to the current healthcare law requirements.

After the release of the Bill, four Republican Senators have stated they are not ready to vote for the Bill but are open to negotiations. For the Bill to pass the Senate, 50 yes votes are needed. Currently, the Bill has no support from Senate Democrats. This means only two Republican votes can be spared to move the Bill back to the House for consideration. Republican Senators Ted Cruz of Texas, Ron Johnson of Wisconsin, Mike Lee of Utah, and Rand Paul of Kentucky do not believe that the current draft accomplishes the promise of repealing the ACA and lowering health care costs. Following the analysis by the CBO, additional Republican Senators are expected to oppose the bill. The Bill is also opposed by the American Medical Association.

The President has suggested that if a replacement for the Affordable Care Act cannot be agreed upon, the Act could be repealed immediately and replaced at a later date. This concept has already been picked up on by some Republican Senators as well, considering a two-stage approach to be an appropriate back-up plan if a compromise is not reached. However, several Republicans and Democrats alike have cautioned against a repeal-then-replace strategy, arguing that it is irresponsible to delay a viable replacement policy.

Written by Melissa Sheffer for the Milwaukee Area Science Advocates

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