Senate Releases Revised Healthcare Bill

Alicia Ault

July 13, 2017

The Senate has released the most recent version of its healthcare bill, and it appears that it may still not satisfy enough legislators to ensure passage.

Among the revisions: Insurers could choose to sell plans that do not cover the essential health benefits mandated by the Affordable Care Act (ACA) as long as they also sell ACA-compliant plans. That new element appears similar to a proposal by Republican Senators Ted Cruz of Texas and Mike Lee of Utah.

The American College of Physicians took issue with that proposal in a statement, saying it would "make the bill even more flawed and therefore even more harmful to our patients by creating new and perhaps insurmountable coverage barriers for patients with pre-existing conditions and by severely weakening or completely eliminating requirements that insurers cover essential health benefits and abide other protections like a community rating."

The organization wrote to Senate leaders reaffirming what it called its "strongest possible opposition" to the revised Better Care Reconciliation Act (BCRA).

The American Psychiatric Association (APA) also expressed consternation about the new bill, and the dropping of the essential health benefits requirements, saying it would roll back access to care for mental illness and substance-use disorders. 

"Wordsmithing and throwing money at certain constituencies to gain more votes highlights a deeply flawed Senate proposal that is insufficient," said APA CEO and Medical Director Saul Levin, MD. 

But even as Senate Majority Leader Mitch McConnell unveiled the latest proposal on July 13, two other Senate Republicans, Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, were on CNN vowing to soon introduce their own version of a replacement for the ACA.

The revised BCRA released today still calls for a radical overhaul of Medicaid, as well as instituting spending caps and allowing states to impose work requirements for able-bodied adults. But in a new addition, it would give states flexibility to lift those caps in the case of public health emergencies. As in the previous version, starting in 2021, the federal government would phase out the more generous Medicaid match promised under the ACA.

The previous version would only allow cost-sharing subsidies for individuals earning up to 350% of the federal poverty level, as opposed to the 400% allowed under the ACA. The revised Senate bill makes no changes to that 350% cap.

Under the revised bill, however, the federal government would add another $70 billion to a fund to help states reduce premiums and otherwise subsidize residents' out-of-pocket costs. The previous Senate proposal already offered $100 billion for that purpose.

Republican senators have long promised to eliminate several of the ACA taxes that help pay for the law and had included those changes in the previous version of the bill, but in the revised version, those taxes remain. One is on high-earning health insurance executives, and several others are levied on higher-income Americans. A repeal of taxes on medical devices and tanning salons are still in effect under the revised bill.

Individuals could buy a catastrophic insurance plan and receive tax credits for doing so if they are eligible, according to new proposals under the revised bill. Another new proposal is to allow individuals to use health savings accounts to pay for their premiums.

The bill would provide $45 billion to address the opioid epidemic, up from $2 billion for 1 year in the previous Senate bill.

Almost 500 organizations wrote to the Senate leaders to say that "the inclusion of additional targeted grant funding for opioid use disorder treatment and recovery support services does not alleviate our concerns with the legislation as grant funding cannot replace sustainable Medicaid reimbursement."

That letter — from the Coalition to Stop Opioid Overdose and 465 other groups, including the American Nurses Association, the American Psychiatric Association, the American Society of Addiction Medicine, the National Alliance on Mental Illness, the National Association of Pediatric Nurse Practitioners, the National Association of Social Workers, and the Partnership for Drug-Free Kids — also registered concern about capping Medicaid and the proposal to allow policies that do not cover essential health benefits.

In a statement, Frederick Isasi, executive director of the liberal advocacy group Families USA, called the bill "the worst yet."

Both a new Congressional Budget Office analysis that will weigh in on the cost of the revised bill and a Senate vote are expected the week of July 17.

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