Currently, the Senate works on applying changes to the Better Care Reconciliation Act. The bill has many areas in need of improvement due to contention with former laws passed by the ACA. Among some of the areas causing friction are the gradual elimination of ACA’s Medicaid expansion; the size and scope of the premium tax credits; the general funding structures of the bill; which ACA taxes to keep or scrap; the overall dramatic changes to Medicaid funding; and lastly the funding for the opioid epidemic.
Currently, 10 Republican senators have expressed their resistance to some of the changes that will come with the BCRA draft. Senate Republicans don’t have much room to lose votes for the passage of the bill into the upper chamber. September 30th has become the hard deadline for any bill to be signed into law. President Donald Trump suggested repealing the bill now and waiting to replace it until later with a better solution. This idea was originally suggested by some Republicans in January. It received a negative response due to the immediate cut of benefits, which undercut the pledge that nobody would lose their coverage under a Republican plan.
The current replacement plans have not received much support due to its coverage losses. Around 22 million Americans are to become newly uninsured, while still spending billions of dollars on the replacement plan. This has caused uncertainty by moderates. In turn, Congress is searching for a way to pass a replacement that avoids coverage losses. Ideally, Congress will devise a plan to repeal and replace simultaneously because moving forward with an ACA repeal without renewal would require Democratic support for eventually producing a replacement package.
BCRA Proposed Changes
Some changes that have been proposed but not necessarily amended to the BCRA are the following:
- Permit insurers to sell any type of non-ACA compliant health plans as long as they also sell at least one ACA compliance plan.
- Permit individuals to pay for premiums using funds from a health savings account. This effectively equalizes the tax treatment of health insurance for those in the individual market from those who receive employer-sponsored insurance. This change comes from a request from Senator Cruz.
- Provide $45 billion over 10 years for substance abuse treatment, specifically aimed at the opioid epidemic. This is targeted at garnering support from Senators Rob Portman (R-OH) and Shelley Moore Capito (R-WV), both of whom have asked for more funding than the $2 billion in 2018 initially provided for opioid funding in the BCRA.
- Retain the ACA’s net investment tax, valued at $172.2 billion over 10 years, to help offset the costs for low-income individuals to purchase health insurance with tax credits. The tax is a 3.8% surcharge on investments for individuals who earn more than $250,000 per year. Retaining the tax would also help to ease perception of the bill as a tax-break for the wealthy while cutting benefits for lower-income Americans.
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