After writing and revising it behind closed doors, Senate Republicans revealed their newest plan to repeal and replace Obamacare on June 22nd—The Better Care Reconciliation Act. Originally, Senate Majority Leader Mitch McConnell hoped to vote on the BCRA before the 4th of July recess, but it became apparent that several Republican senators still had concerns about the bill, namely Sen. Dean Heller (Nevada), Rand Paul (Kentucky), Ted Cruz (Texas), Mike Lee (Utah), and Ron Johnson (Wisconsin). The Congressional Budget Office (CBO) released their report on how the draft would affect Americans on June 26th, so we are now more informed about the implications of a supposed implementation of the bill.
Because—although it may seem contradictory—states with Republican senators such as Louisiana tend to have the most people depending on the Affordable Care Act, some Republican senators have dissented and challenged the BCRA, requesting that more people from their states be covered. Ultimately, compromises will likely need to be made to pass the bill and replace Obamacare.
However, the current draft is what is in the Senate’s hands, and I want to analyze the major differences between it and Obamacare.
The CBO report stated that around 22 million fewer people would be insured with the BCRA than with our current healthcare system. By 2026, an estimated 49 million people would be uninsured, compared to 28 million who would lack insurance that year under current law.
This is one of the main concerns have about new healthcare bills, and is a hotly debated topic. Obamacare provides entirely for pre-existing conditions, but it’s more complicated for the Senate bill. The two main parts of this that are mentioned in Obamacare are:
- Guaranteeing coverage even for people with pre-existing conditions.
- Banning insurers from charging people based on their health.
Originally, the House bill (the American Healthcare Act) allowed states to opt out of the second condition, but the BCRA does not. Instead, the Senate bill allows states to redefine what providing “essential” health benefits means. This could help decrease insurance premiums, but it could also decrease coverage of different health services.
Another hotly-debated part of Obamacare is the individual insurance mandate—under Obamacare, recipients could choose to either have health insurance or pay a penalty. The BCRA would fully reverse this mandate, thus giving more freedom to the people about whether they want to purchase healthcare or not.
With Obamacare, Medicaid expands indefinitely, allowing states to provide for low-income Americans. In the BCRA, Medicaid would continue to expand Medicaid for three years, and then roll it back in 2021. This means that fewer people will have access to Medicaid in those years.
Obamacare reimburses for most Planned Parenthood services, while the Senate draft blocks Planned Parenthood reimbursements for one year. The CBO estimates that 15 percent of women would lose access to family planning care.
Caring for people with disabilities was a vital part of Obamacare; currently, most money spent on Medicaid goes toward it. The CBO suggests that services for people with disabilities could be cut as federal funding continues to decline.
Mental Health Services
Once again, Mental Health services are covered by all plans in Obamacare. However, in the BCRA, states could request to opt out of requiring essential heath benefits. This would make mental healthcare “extremely expensive” according to the CBO.
In both Obamacare and the Senate draft, nursing care is covered for 100 days per illness. Services could be cut as funding to states declines.
People Under 26
Nothing changes for the young. They can still get insurance through their parents’ plans.
People from 50-64
The elderly would suffer the most from the BCRA, and coverage is shifted disproportionally from them to younger adults. Under Obamacare, they would have to pay around three times what the youngest pay, but under the BCRA, they would have to pay five times as much.
With Obamacare, states can opt-in to offer expanded coverage to people who fall just below the poverty line. In the BCRA, this will be phased out between 2021 and 2023. By this time, eight states will have the expansion go away immediately.
Obamacare was largely funded by taxes on large corporations and the wealthy. The Senate bill plans to remove all the said taxes, leading to a tax cut totaling $563 billion over ten years according to the CBO. While this may seem like a lot, these cuts are balanced by the lessening of services provided by the new plan.
The BCRA likely needs more work before it can be passed, and I hope that it will receive bipartisan support when it does. Over the course of this summary, we have seen that the new bill focuses on Republican value of “low taxes, low spending” to keep the BCRA afloat. Because of this, no Senate Democrat has expressed support in the bill. This isn’t the way politics should work. Passing the bill on a party-line vote, even if the five dissenting Republicans are swayed onto the side of it, will only lead to more opposition in the future. Instead of writing behind closed doors, Senate Republicans need to work with Democrats to craft a bill that can both mitigate the flaws of Obamacare and maintain its widespread coverage.