Despite Changes, Senate Health Reform Bill Still Very Problematic for Washington

July 13, 2017

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.

Read more about our position and access additional resources at 

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. 

Letter to the Senators

WSHA will be sending a letter to both of Washington State’s Senators, Patty Murray and Maria Cantwell, thanking them for their continued opposition to proposed reductions in health coverage.

Next Steps in the Process

A vote of the full Senate could come as early as next Thursday or Friday. First, however, the CBO will analyze the bill’s impact on coverage levels and the federal budget – that report is expected Monday. Then the Senate parliamentarian will review the bill and the CBO’s report to determine whether the bill’s provisions are germane under the Senate’s budget reconciliation rules.
If it is, the Senate will begin floor consideration with a vote on a “motion to proceed” to debating the BCRA, possibly on Tuesday.  If that cloture motion is approved by a simple majority of members, the Senate will have 20 hours of debate on the bill, during which senators can offer unlimited amendments.
It is important to note that today’s version of the BCRA is likely to evolve as Republican leaders seek the 50 votes they need to pass the bill or respond to the CBO’s findings and the parliamentarian’s rulings. 
If the bill passes the Senate, it then goes back to the House, where lawmakers could merely accept it and send it to the president or object. If they object, then a House-Senate conference committee would draft a final bill that would need to be approved again by both chambers. 
WSHA will continue to keep you informed of this process. If you have any questions, please feel free to reach out to Chris Bandoli or Chelene Whiteaker. 


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