Senate health-care bill still unworkable and unfixable

The U.S. Senate has now turned its attention back to reviving the Better Care Reconciliation Act (BCRA)–a bill that simply cannot be fixed and is incredibly unpopular. Approval of the bill among the American public has hovered between 12 and 27 percent. A newly released report from the Congressional Budget Office shows the latest version would eliminate coverage for 22 million people and cut Medicaid by $756 billion over the next decade.* The newest CBO score looks much like the nonpartisan group’s analyses of the previous four versions of House and Senate health-care legislation.

The similarity of all five CBO scores highlights what has been clear since the first version of the BCRA was released: the bill is unfixable because its core elements — major cuts to Medicaid and federal subsidies — would take coverage away from millions of people and make insurance more expensive for millions more. In Louisiana, the most recent version of the Senate bill would take coverage away from 399,000 residents by 2022, which is only a slight improvement upon previous versions of the Senate health-care plan. And, since the number of people receiving coverage through Medicaid expansion is expected to grow, these estimates may understate the actual coverage losses.

Still, the Senate is now discussing additional changes to the BCRA in an attempt to cobble together support from 50 senators. But, the major provisions of the bill are expected to remain the same.

Provisions that remain from previous versions of BCRA:

• Rolling back federal support for Medicaid expansion
• Capping and cutting the traditional Medicaid program
• Slashing federal funding that reduces people’s out of pocket costs
• Weakening the ACA’s consumer protections for people with pre-existing conditions
• Increasing the “age tax” on older Americans
• Providing hundreds of billions of dollars in tax cuts for high-income households, drug companies, and other corporations.

Proposed change to the bill:

• Providing $200 billion in federal funding for Medicaid expansion states to reduce costs of private insurance for those who lose Medicaid coverage when expansion is reversed.

Adding $200 billion to the BCRA is a futile attempt to reduce the massive coverage losses that would result from rolling back the Medicaid expansion. The new funding being discussed would equal just 17 percent of the total cuts to Medicaid and the marketplace subsidies in the BCRA. In Louisiana, more than 500,000 adults are expected to be enrolled via expansion by 2020, when the enhanced federal funding would begin to phase out. While they would be newly eligible for federal subsidies under the BCRA, CBO estimates the average deductible for a benchmark plan in 2026 would be $13,000 per year, which would consume the entire income of a Louisianan with income at 75 percent of the federal poverty line.

The 143,600 Louisianans who purchase insurance in the individual marketplace would see their net premiums increase by an average of 105 percent by 2026, according to an analysis by the Kaiser Family Foundation. The average Louisiana consumer would see her premiums increase from $179 to $368 per month. The $200 billion the Senate is considering adding to the BCRA would do little or nothing to address their increased out-of-pocket costs.

The Senate bill is highly unpopular for good reason. It does not address the existing problems in the nation’s health-care system and makes some of them worse. It is time for Congress to start over on health care and proceed in the direction nearly three-quarters of Americans support: working toward a bipartisan solution that ensures stability in the marketplaces, reduces out of pocket costs, protects people with pre-existing conditions and increases the number of Americans with coverage.   

*The July 20 report from CBO does not include an analysis of the “Cruz amendment” which would allow insurers to offer plans that do not comply with Affordable Care Act consumer protection requirements. That change would have caused a dramatic increase in premiums for comprehensive coverage, making good coverage unaffordable for moderate-income, older Americans with pre-existing conditions.