This Thursday, Senate Republicans finally released their plan to repeal and replace Obamacare: the Better Care Reconciliation Act (BRCA).
The drafting process was short, secret, and—as a result—controversial. Most important and complex legislation is debated and defended in committee, which did not happen here. The reasons for this are probably: a) to distance President Trump from the process and b) to limit discussion of an unpopular bill that only needs Republican votes to pass.
The Senate is expected to vote on the bill next week.
Why is it important?
We'll know more about who the bill will affect and how when the Congressional Budget Office score comes out. But based on Sarah Kliff's analysis, we know BRCA will:
- Dramatically cut Medicaid, ending the Obamacare expansion and limiting state spending on the program.
- Reduce the Obamacare individual mandate to nothing by setting the penalty to zero dollars.
- Shrink subsidies and the health insurance they cover.
- Cut taxes on families making more than $200,000 per year.
- End federal support for Planned Parenthood for at least one year.
Should Congress pass the Better Care Reconciliation Act?
This bill will strip health care from millions. Republican legislators refuse to consider its effects—voting the same week the CBO score comes out—for one simple reason: They don't believe the government should ensure everyone can get health care at all. This bill is the disastrous result of that unpopular view.
In theory, this health care debate represents a historic shift: Both parties are debating how the federal government should ensure Americans can get affordable insurance as opposed to whether the government should have a role in health care at all.
But this bill reveals it's only a shift in name, not reality. Both the House and Senate bills are designed to remove health care subsidies and coverage from a huge number of people. The bill "asks low- and middle-income Americans to spend significantly more for less coverage."
This Republican leadership lied for years promising "universal coverage for all." No reasonable person could look at the House bill's CBO score—23 million more Americans uninsured—and think it does anything close. And Republicans are planning to vote on the bill next week, at the same time the CBO score comes out.
Why would you pass a bill before you've considered its effects? Because there is no number of Americans losing health insurance that would matter. Both House and Senate leadership believe that government should not be responsible for your health care. These bills are heedless steps toward that future.
The idea that this bill is responding to calls for reform is patently false. 60% of American citizens believe the government should be responsible for ensuring health care coverage for all Americans—the highest share in nearly a decade. Your representatives do not share this perspective. This bill reflects their view, not yours.
This bill is the health care reform we need. It improves the House plan, addresses key problems in Obamacare, and responds to Americans' clear call to change the crumbling system we have.
You may disagree about the cause, but Obamacare is falling apart. Premiums are increasing by 25% per year. One-third of all U.S. counties with only one insurer offering plans on their state’s exchange. And 34% fewer health care providers accepting Obamacare versus private insurance. We need to make the most of this opportunity for reform, for the sake of all Americans and the sustainability of our health care system.
The BCRA preserves the parts of Obamacare American's like and gets rid of many that are harming them. If you're under 26, you can stay on your parent's insurance. If you don't want to buy insurance, you no longer face a penalty for your decision.
It also makes several major changes that will benefit many Americans. It replaces the Obamacare Medicaid expansion with tax credits, allowing low income Americans more flexibility in purchasing their insurance. It also gives insurance companies more leeway in deciding what those plans cover—a necessary and reasonable trade-off.
The bill also gives states the flexibility they need. As reporter Avik Roy writes, states will be able to "open up their private insurance markets to innovation and competition, through a new set of Section 1332 waivers in which the validity of the waiver applications will be assumed by the federal government so long as the plan doesn’t increase federal spending. Furthermore, the bill offers states around $100 billion in stability and innovation grants that states can use to shore up their insurance markets, by providing extra assistance to the needy or the sick."
This shift toward flexibility will allow the kind of customization that our health care system will need to be sustainable long-term.
- The text of the Senate bill, the Better Care Reconciliation Act
- The text of the House bill, the American Health Care Act
- The major takeaways from the Senate bill
- "The bill asks low- and middle-income Americans to spend significantly more for less coverage. The bill would roll back the Affordable Care Act’s expansion of the Medicaid program, which currently covers millions of low-income Americans, and include additional cuts to Medicaid. It would rework the individual market so that enrollees get less financial help to purchase less generous health insurance with higher deductibles."