On June 22, the Senate released the Better Care Reconciliation Act of 2017 (BCRA) - its version of repealing and replacing the Affordable Care Act (ACA). The Senate version comes weeks after the House passed its version, the American Health Care Act (AHCA), by a narrow four vote margin on May 6th.

The Senate’s BCRA would make several key changes to programs and policies created by the ACA. Key provisions of the Senate bill: 

• Eliminates individual mandates;
• Eliminates cost-sharing subsidies for low-income Americans to buy coverage on Marketplaces;
• Creates a new waiver process that allows states to change or eliminate certain ACA requirements such as basic benefit packages and minimum actuarial value of insurance products;
• Eliminates Medicaid expansion through a three year phase-out beginning in 2021;
• Changes federal Medicaid funding to a one based on a set amount per enrollee;
• Alters eligibility for subsidies for those buying coverage on the Marketplaces to those with income below 100% of Federal Poverty Level (FPL) to 350% FPL.
  • ACA eligibility for subsidies ranges from 138% FPL and 400% FPL
• Creates a new fund to help communities fight the opioid epidemic; and
• Repeals all new taxes created under the ACA.

Provisions mentioned in this article may have changed by date of publish.

While there are differences between the Senate and House versions of ACA reform, namely the Senate’s more significant changes to Medicaid, both bills can be viewed as a similar approach to lower premiums through less regulation and greater state flexibility.

As was the case with the AHCA, the Senate’s BCRA would not directly impact URAC as the provisions relating to external reviews handled by URAC accredited IROs and the Health Insurance Marketplaces are intact. However, there may be potential changes to the Marketplaces, undertaken by states through waivers, should either bill be signed into law. Any changes that come as a result will be closely tracked for their potential impact on URAC.

Originally, the Senate planned to hold a vote prior to the July 4th holiday but due to a lack of support regarding the initial draft of the BCRA, the Senate has postponed a vote until the week of July 10th.

In order to win additional support in advance of the final vote on the legislation, Senate leaders are expected to make changes to initial legislation described above.

Here is more information on the impact of the BCRA as estimated by the Congressional Budget Office.

If you’d like more on the politics of the BCRA, check out this article from Politico. If you’d like to compare the BCRA, AHCA, and the ACA, here is a chart from Kaiser Family Foundation.

Finally, if you’re looking to kill 20 minutes, check out my interview with the NBC 4 Washington on the Senate legislation.

As always, if you have any questions or would like to discuss this in more detail please feel free to contact me at aturner-phifer@urac.org or 202-326-3957.