In efforts to appease both conservatives and moderates, the Senate GOP has revised the Better Care Reconciliation Act (“BCRA”), the GOP’s bill to repeal and replace the Affordable Care Act (ACA).
Repealing ACA remains a top priority for President Trump and House Republicans who passed their own repeal bill, the American Health Care Act (“AHCA”) back in May. Like the initial version released in June, the revised bill still includes drastic Medicaid cuts and a conversion of Medicaid from a system of open-ended entitlement to one of fixed payments to the states. However, in an effort to appeal to moderates, the bill also provides states with about $70 billion in funds to help reduce premiums and limit out-of-pocket medical expenses for individuals who may have difficulty obtaining affordable insurance. Significantly, the new version of the bill would allow individuals to use health savings accounts (HSAs) to pay insurance premiums with pre-tax dollars in addition to out-of-pocket costs, a policy change that will increase health care coverage according to Republican supporters. It is widely speculated that even though the House and Senate ACA “repeal and replace” bills would halt enforcement of the employer mandate, few employers are likely to stop offering group health coverage to their employees if ACA is repealed.
Still, an imminent repeal of ACA is far from guaranteed, as a number of Republicans remain uncomfortable with spending reductions to Medicaid. There are also those who believe that having HSA funds help pay for insurance premiums would fail to cover the gap between the financial assistance that people would receive under the BCRA versus the ACA, especially lower-income people with pre-existing conditions. Thus, the revised BCRA still faces considerable opposition from Senate Republicans. The bill needs to get at least 50 votes to pass, which could be a near-impossible feat.