Are changes to Better Care Reconciliation Act enough to pass Senate?

The Senate released an amended version of the Better Care Reconciliation Act (BCRA) today with few significant changes to the original version, which was unveiled several weeks ago. 

 The original version of the BCRA faced public backlash as well as criticism within the Republican Party. The CBO score of the bill projected 22 million additional Americans would lose coverage and it would cause a significant increase in health care premiums.

In response, the Senate Republicans have worked diligently to amend the plan in hopes it will draw enough support from both moderates and conservatives to pass.

The most significant change in the new version of the BCRA is an amendment proposed by Senator Ted Cruz that would allow insurers to offer cheaper health care plans that are not Affordable Care Act (ACA) compliant, as long as insurers continued to offer a subset of ACA compliant plans. In theory, this would encourage insurers to provide a variety of plans with various coverage options, leading to more options and lower premiums for less comprehensive plans.

Other notable changes to the BCRA include:

  • Several of the ACA’s taxes on the wealthy remain in this version of the bill. These taxes were repealed in the original BCRA.
  • Individuals and families would be permitted to use funds from their Health Savings Accounts (HSAs) to pay for health care coverage premiums.

The Senate did not change the BCRA’s deep cuts to the Medicaid program, which are a huge point of contention for moderate Republicans that have adopted Medicaid expansion within their states. These Medicaid cuts could significantly impact the likelihood of the bill passing the Senate as they are a major reason why fewer Americans would be covered by health care under BCRA. 

The Congressional Budget Office is expected to release new projections for the amended bill on Monday. 

An alternate plan

Immediately prior to the release of the updated version of the BCRA, Republican Senators Lindsey Graham and William Cassidy proposed an alternate plan in the event that the BCRA fails to gain the necessary votes to pass the Senate.

This plan would primarily give health care control back to the states. The money collected from ACA taxes on wealthier individuals would be given back to the states in block funding. States would then determine their own health care policies. This would allow states that like the ACA to adopt their own version of the legislation, and enable others to pave their own path. 

We can certainly expect reactions from both sides of the aisle today, and there will be even more after the CBO score is released on Monday.  In the coming weeks, stay tuned to see whether Senator Mitch McConnell will be able to pull off the delicate balancing act of gaining support within his own party, or if the Republicans will move on from the BCRA and find an alternative plan.