Senate Delays Final Vote on ACA Repeal Legislation

The Better Care Reconciliation Act of 2017 makes several key changes to the American Health Care Act (AHCA), the House version of the bill passed in May, such as continuing expanded Medicaid funding from the ACA for an additional year and maintaining Obamacare’s premium subsidies, in an effort to appease moderate Republicans. At the same time, the Senate bill keeps intact many of the same provisions insisted on by more conservative party members, including removal of the individual and employer mandates that levy tax penalties for not carrying or offering insurance.

Medicaid and the premium subsidies have been some of the largest sticking points in the debate over the bill. For Medicaid, both chambers’ versions of the bill would change the open-ended entitlement program to one where states would either receive a fixed amount of money annually based on enrollment or as a lump sum block grant.

And while the Senate version does extend Obamacare funding levels to 2021 (as opposed to 2021 in the AHCA), the annual growth rate of those funds would be tied to standard inflation instead of the more generous medical inflation rate beginning in 2025. Opponents of the bill say this will force states to make cuts to enrollment, benefits or provider payments, all of which would be detrimental to coverage. In total, the two bills together would cut spending on Medicaid by about $880 billion, according to MedPage Today.

In a move to mollify more moderate Senate Republicans, the BCRA looks to maintain the premium subsidies established under the Affordable Care Act. Currently, those subsidies are available to individuals and families earning up to 400 percent of the poverty level, but the BCRA would reduce the threshold to 350 percent. Subsidies would be made available to those below the poverty line if they are not eligible for Medicaid.

Other highlights of the bill include:

• States would not be allowed to opt out of mandated coverage of those with pre-existing conditions (an AHCA provision);
• States would be allowed to determine what services are categorized as “essential health benefits” that must be guaranteed to be covered;
• Children would still be allowed to remain on their parents’ health plan until age 26; and
• Funding is assured in 2018 and 2019 for additional Obamacare-mandated cost-sharing subsidies for insurers.