July 13, 2017 Senate Republican leaders release revised Better Care Reconciliation Act Senate Republican leaders on July 13, 2017, released an updated discussion draft of the Better Care Reconciliation Act (BCRA), the Senate's version of the ACA repeal and replace legislation. A Congressional Budget Office (CBO) score for this revised draft is expected early next week. Key changes from the previous version include: — High income tax provisions remain in place: The new bill does not repeal the net investment income tax, the additional Medicare Health Insurance (HI) Tax, or the remuneration tax on executive compensation for certain health insurance executives. — Additional $70 billion for out-of-pocket costs: $70 billion in funding is added to the $112 billion in the original bill and could include support cost-sharing, Health Savings Accounts (HSAs), and other mechanisms to pay for health care costs. — Health Savings Accounts to pay for premiums: A new provision would allow people to use their HSAs to pay health insurance premiums. — Additional $45 billion to combat the opioid epidemic: $45 billion dedicated to substance abuse treatment and recovery. — More options for purchasing lower-premium plans: Anyone in the individual market would be allowed to purchase a lower-premium health insurance plan, including those with federal tax credit assistance. Individuals who enroll in catastrophic plans would be eligible for the tax credit if they meet other tax credit eligibility requirements. — New fund for high risk individuals: Creates a fund dedicated to making payments to specified health insurance issuers for the costs of covering high risk individuals. To qualify, an issuer must offer an ACA Title I compliant plan on the Exchange which would then allow the same issuer to offer coverage off-Exchange that would not be required to meet all ACA Title I requirements. — Medicare revisions: — The Disproportionate Share Hospital (DSH) payment provision calculation will be based on the number of uninsured people instead of the number of Medicaid enrollees. — States may apply for a waiver to continue and/or improve home and community-based services for aged, blind, and disabled populations. — If a public health emergency is declared, state medical assistance expenditures will not be counted toward the per capita caps or block grant allocations. — An expanded block grant option allows states to count the Medicaid expansion population within their block grant if they opt to do so. Senate Republicans leaders have indicated that they intend to bring the revised bill to the Senate floor next week for consideration. Additional changes are possible as leaders seek to gain additional support for the bill. Attached are: 1. Updated Legislative Text 2. Updated Section-by-Section Summaries 3. A New Summary that identifies the revisions to the previous discussion draft ———————————————
——————————————— Better Care Reconciliation Act of 2017
BCRA Section by Section Summary
BCRA Title III Summary
Revisions to the BCRA
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