After weeks of secrecy, Senate Republican leaders have finally released a draft version of the budget resolution they intend to use to repeal and replace much of the Affordable Care Act.
The 142-page bill [PDF], now dubbed the Better Care Reconciliation Act, will likely undergo additional changes in the coming days, as GOP leadership attempts to move forward with a vote before the early July recess.
Like the House version, it seeks to end the mandates that most individuals have health insurance and that most larger employers provide insurance. It does not currently include a provision from the House bill which tried to prevent people from dropping their insurance by dangling the threat of a 30% premium surcharge for people who had let their coverage lapse.
While the House GOP has been suing the government to stop federal ACA subsidies to private insurance companies, the Senate bill would effectively allow these payments to continue through 2021. In fact, these payments, intended to help insurers keep premiums affordable, will be larger in the coming years. The Senate proposal would pay out $15 billion annually in 2018 and 2019 through this “Short-Term Stabilization Fund,” with that dropping to $10 billion for 2020 and 2021.
The bill also provides for a “Long-Term State Innovation Fund” of $62 billion spread out over 8 years, intended to help states provide coverage for residents in either high-risk or low-income categories.
Just like the House bill, the Senate will provide tax credits to help people purchase their own coverage. Unlike the house bill, which used age as the primary determining factor for the size of the credit, the Senate bill would include considerations for income.
The Senate is also leaning heavily on expanded use of Health Savings Accounts as a way for Americans to pay for their coverage. However, critics of this plan have argued that HSAs only benefit those who can afford to save significant portions of their income. Lower-income Americans or people with significant expenses who aren’t able to contribute to an HSA would have difficulty taking advantage of this change to the law.
In terms of the ACA’s Essential Health Benefits — those insurance benefits that insurers must provide under current law — the Senate appears to be following the House lead by allowing states the opportunity to determine what is considered “essential” for coverage in that state.
We’re still sorting through this bill and will continue to update as more details become clear…