Today, U.S. Senate Republican leaders released a new version of the Better Care Reconciliation Act (BCRA); a vote on the bill is possible next week.
The Washington State Hospital Association remains deeply concerned with the Senate’s approach to repealing and replacing the Affordable Care Act (ACA). Most of the underlying provisions of the new bill, including deep cuts to Medicaid, are unchanged from the previous draft and will result in dramatically fewer Washingtonians having access to health coverage and care.
The Washington State Hospital Association strongly believes that health insurance is necessary for people to live healthy, productive lives. Our goal is to ensure that low- and moderate-income people in our state can continue to be covered by health insurance. Health coverage opens the door to good primary care, it keeps people out of the ER and helps control overall health care costs—costs that are ultimately shared by everyone.
Similar to the House and previous Senate bills, this iteration falls far short of that goal, and WSHA strongly opposes it.
Main provisions of the bill include:
- Decrease in individual market protections. The bulk of the new changes are intended to stabilize risk pools and drive down the cost of health plans offered in the individual insurance market. Most notably, the bill would allow insurers to offer “non-compliant” plans that do not include many of the existing consumer protections, such as the requirement to cover a package of “essential health benefits.” Provisions such as this will likely result in fewer low-income and vulnerable consumers having access to affordable, comprehensive health plans. The primary health insurance trade association recently rejected this approach, arguing that its adoption would undermine the stability of the exchange marketplaces that are already working.
- Medicaid DSH cuts are maintained in expansion states. The new bill offers restoration of Medicaid DSH cuts and a potential increase if Washington State eliminates coverage for Medicaid expansion. While this would provide some relief from the hospital cuts that were in the ACA, but Washington would also have to give up Medicaid expansion and eliminate insurance for the 600,000 people who received coverage. DSH cuts are only a sliver of the cuts hospitals took, so a restoration of these cuts does not make hospitals whole.
- Decrease in funding for Medicaid expansion. This Senate bill, like the last version, phases out support for Medicaid expansion between 2021 and 2023 – from 90% to 75%. In 2024, the federal government would pay only 50 percent of the cost of services provided to the expansion population, instead of the 90% that in current law.
- Elimination of the individual and employer mandates;
- Reduction in subsidies to purchase coverage. The bill reduces subsidies for lower-income individuals to purchase insurance coverage and reduce cost-sharing obligations; and
- Continued cuts to hospitals. The new bill maintains the Medicare Disproportionate Share Hospital cuts, as well as Medicare payment cuts.