Yesterday, Senate Republicans released a discussion draft of their proposal to repeal and replace the Affordable Care Act (ACA), titled the “Better Care Reconciliation Act of 2017” (BCRA). Beyond the title change, there are notable differences between the House-passed American Health Care Act (AHCA) and the Senate version, including a slower phase-out for the Medicaid expansion, retention of the ACA’s premium subsidy structure, somewhat reduced state waiver flexibility and delayed implementation of effective dates for certain ACA tax provisions.
The Congressional Budget Office is expected to release its cost estimate for the BCRA early next week, with Senate Majority Leader Mitch McConnell (R-KY) aiming for a floor vote before the July 4 recess week. Early resistance from a handful of both moderate and conservative senators (including Sens. Ted Cruz (R-TX), Rand Paul (R-KY) and Dean Heller (R-NV)) threatens the BCRA’s passage, but negotiations are ongoing, and additional changes are expected before the bill comes up for a vote.
Like the AHCA, the BCRA would not repeal the ACA in its entirety—partially due to conscious policy decisions, but also because of procedural limits within Senate Budget Reconciliation rules. For instance, both the AHCA and the BCRA would maintain some of the “popular” insurance market reforms in Title I of the ACA, such as rules requiring issuers to offer dependent coverage until age 26, prohibitions on annual and lifetime limits, and prohibition of discrimination based on race, nationality, disability or gender. Further, neither bill proposes changes to any Medicare provisions from Title III of the ACA, such as those implementing quality- and value-based provider payment reforms (many of which are budget neutral), the Center for Medicare and Medicaid Innovation, and provider rate cuts (repeal of which would add to the deficit outside of the 10-year budget window in violation of procedural rules).
Click here to read the full summary of how changes in the BCRA compare to the AHCA.