Discussion Draft - Better Care Reconciliation Act (BCRA)
View the June 26, 2017 draft of the Better Care Reconciliation Act (BCRA) here.
REVISIONS TO THE BETTER CARE RECONCILIATION ACT
After extensive consultations across the Senate Republican Conference, below are the primary revisions to the Better Care Reconciliation Act (BCRA) discussion draft:
MORE HELP TO COVER OUT-OF-POCKET COSTS:
An additional $70 billion is dedicated to encouraging state-based reforms, which could include help with driving down premiums through cost-sharing, Health Savings Accounts (HSA), and other innovative ideas to help pay for health care costs. This is in addition to the $112 billion in funding already in the original bill.
HEALTH SAVINGS ACCOUNTS TO PAY FOR PREMIUMS:
In order to ensure that more people have financial support to pay for health care costs, a provision has been included in the bill that would, for the first time, allow people to use their HSAs to pay for their premiums. This is a policy that both the Joint Committee on Taxation (JCT) and the Congressional Budget Office (CBO) say will increase health care coverage.
ADDITIONAL RESOURCES TO COMBAT THE OPIOID EPIDEMIC:
With the opioid crisis hitting Americans in every state, an additional $45 billion is dedicated for substance abuse treatment and recovery.
MORE OPTIONS FOR AMERICANS TO BUY LOWER-PREMIUM PLANS:
Individuals who enroll in catastrophic plans would be eligible for the tax credit so long as they meet other tax credit eligibility requirements. Obamacare prohibited individuals enrolled in catastrophic plans from receiving a tax credit even if they met all other eligibility requirements.
Anyone in the individual market would be allowed to purchase a lower-premium health insurance plan, including Americans with their federal tax credit assistance. These plans are higher deductible plans that cover three primary care visits a year and have federal protections that limit an individual’s out-of-pocket costs.
The new draft bill will not include any changes from current law to the net investment income tax, the additional Medicare Health Insurance (HI) Tax, or the remuneration tax on executive compensation for certain health insurance executives.
To allow for more accurate Disproportionate Share Hospital (DSH) related decisions and maximum benefit to states to assist in providing uncompensated care, the new discussion draft changes the DSH calculation from per Medicaid enrollee to per uninsured.
To improve management of vulnerable populations, states may apply for a waiver for the purpose of continuing and/or improving home and community-based services for aged, blind, and disabled populations.
If a public health emergency is declared, state medical assistance expenditures in a particular part of the state will not be counted toward the per capita caps or block grant allocations for the declared period of the emergency.
Expanded block grant option to allow states to also add expansion population under the block grant if they opt to do so.
Enhanced Focus On Higher Risk Individuals:
Creates a fund for the purpose of making payments to specified health insurance issuers for the associated costs of covering high risk individuals enrolled in the qualified health plans on the Affordable Care Act’s Individual Exchange. In order to qualify for such funds, an issuer must offer sufficient minimum coverage on the Exchange that remains subject to Title 1 mandates. Offering such coverage would enable the issuer to also offer coverage off the Exchange that would be exempt from certain Title 1 mandates.
Overview of the Better Care Discussion Draft
- Help stabilize collapsing insurance markets that have left millions of Americans with no options.
- Short-Term Stabilization Fund: To help balance premium costs and promote more choice in insurance markets throughout the country, this stabilization fund would help address coverage and access disruption – providing $15 billion per year in 2018 and 2019; $10 billion per year in 2020 and 2021.
- Cost-Sharing Reductions: Continues federal assistance – through 2019 –to help lower health care costs for low-income Americans.
- Free the American people from the onerous Obamacare mandates that require them to purchase insurance they don’t want or can’t afford.
- Eliminates the individual and employer mandate penalties.
- Improve the affordability of health insurance, which keeps getting more expensive under Obamacare.
- Long-Term State Innovation Fund: Dedicates $132 billion, over 8 years, to encourage states to assist high-cost and low-income individuals to purchase health insurance.
- Tax Credits: Targeted tax credits will help defray the cost of purchasing insurance; these advanceable and refundable credits - adjusted for income, age and geography - will help ensure those who truly need financial assistance can afford a health plan.
- Health Savings Accounts: Expanded tax-free Health Savings Accounts to give Americans greater flexibility and control over medical costs; increased contribution limits to help pay for out-of-pocket health costs and expensive prescription medications.Additionally, for the first time, individuals will be able to use HSAs to pay for their premiums in excess of any tax benefit they already receive for the purchase of health care.
- Repeals Obamacare Taxes: Repeals costly Obamacare taxes that contribute to premium increases and hurt life-saving health care innovation, like the taxes on health insurance, prescription drugs, medical devices, and “high-cost” employer sponsored plans.
- Empowers states through state innovation waivers: Provides states additional flexibility to use waivers that exist in current law to free their health insurance markets from Obamacare regulations, reduce the cost of health insurance, and better allow customers to buy the health insurance they want. Allows the Department of Health and Human Services (HHS) to fast-track applications from states experiencing an Obamacare emergency.
- Support for State Opioid and Substance Abuse Crisis: Provides $45 billion in state grants to support treatment and recovery support services for individuals who have or may have mental or substance use disorders.
- Strengthen Medicaid for those who need it most by giving states more flexibility while ensuring that those who rely on this program won’t have the rug pulled out from under them.
- Targets Medicaid to Those Most in Need: In 2021, begins gradual reductions in the amount of federal Obamacare funds provided to expand Medicaid, restoring levels of federal support to preexisting law by 2024 while providing fairness for non-expansion states.
- New Protection for the Most Vulnerable: Guarantees children with medically complex disabilities will continue to be covered.
- Provides additional state flexibility to address the substance abuse and mental health crisis.
- Flexibilities for Governors: Allows states to choose between block grants and per-capita allotments for their Medicaid population beginning in 2020, with a flexibility in the calculation of the base year. Allows states to impose a work requirement on non-pregnant, non-disabled, non-elderly individuals receiving Medicaid.
- New Protections for Taxpayers: Curbs Medicaid funding gimmicks that drive up federal costs.
- Enhanced Focus On Higher Risk Individuals by creating a fund for the purpose of making payments to specified health insurance issuers for the associated costs of covering high-risk individuals enrolled in the qualified health plans on the Affordable Care Act’s Individual Exchange.
- In order to qualify for such funds, an issuer must offer sufficient minimum coverage on the Exchange that remains subject to Title 1 mandates.
- Offering such coverage would enable the issuer to also offer coverage off the Exchange that would be exempt from certain Title 1 mandates.