The Senate GOP’s Better Care Reconciliation Act (BCRA) is dead — and yet it lives. On Thursday, the Congressional Budget Office scored a revised but still moribund version of the unpopular Obamacare replacement bill.
This is the second time CBO has scored the Senate Republicans’s repeal-and-replace health bill. But the two scores look markedly similar, down to the finding that replacing Obamacare would cost 22 million people their insurance over the next decade.
Thursday’s score does not account for the controversial Cruz amendment — proposed by Sen. Ted Cruz (R-TX) — which would allow insurance companies to sell non-Obamacare compliant plans along as long as they also sell at least one plan with strong consumer protections.
Under a BCRA that included the Cruz provision, healthy people would not buy Obamacare-compliant plans, premiums would inevitably skyrocket, and eventually the entire market would collapse. This is known as a death spiral. That the CBO did not account for this amendment does not mean it’s dead.
CBO is working on scoring the Cruz amendment, according to staff. No estimate on when it will be ready.
— Margot Sanger-Katz (@sangerkatz) July 20, 2017
Today’s iteration of BCRA has changed only slightly to attract Republican votes. Even with the slight revisions, Republicans remain at least four votes shy of of the majority needed to bring the health bill to the Senate floor. (That estimate is excluding ailing Senator John McCain (R-AZ) of Arizona.) The near-dead BCRA was resurrected after President Donald Trump Wednesday called on senators to repeal and replace Obamacare before the Senate breaks in August.
Same bill, different day
The CBO’s scores of BCRA 1.0 and BCRA 2.0 are nearly identical because the bills are. Shared findings include:
- By 2018, 15 million people would lose insurance. And by 2026, 22 million would lose insurance.
- Benchmark insurance plans offered in “Obamacare” marketplace have an actuarial value of 58 percent. This means insurers will only need to pay 58 percent of out-of-pocket costs. Despite qualifying for tax credits to pay for monthly insurance, few low-to-moderate income people will buy these plans.
- States still have the option to waive market regulations. This means people who do buy insurance will likely buy plans that cover that bare minimum.
- The latest version of BCRA still cuts Medicaid spending; by 2026, federal Medicaid spending would be cut by $756 billion.
Tinkering around the edges
To garner support for repeal-and-replace efforts, Senate leadership tweaked some provisions. Here’s what they added:
- $70 billion dollars in added funds to stabilize the marketplace.
- More money for states to combat opioid epidemic.
- Two Obamacare taxes on big earners will not be repealed after all.
- Slight changes to Medicaid, like limited money to states who declare a public health emergency.
- Residents could also set up a health savings account (HSA). HSA is a type of financial account that allow people to put aside money tax free for medical expenses.
Due to these slight changes, there were slight budgetary changes:
Even with generated revenue from taxes on big earners, premiums and out-of-pocket costs are higher than current law. CBO estimated that someone making $26,500 would see a $13,000 deductible, which is what patients pay before insurance kicks in. Under current law, the deductible is $800. As pointed out by Axios reporter David Nather, this could violate a legal limit on deductibles:
Per CBO: A $13,000 deductible would be higher than the out of pocket limits under ACA. Unless Congress wants to change that too. pic.twitter.com/fMXUZd54SL
— David Nather (@DavidNather) July 20, 2017
Premiums still disproportionately hurt low-to-moderate income adults and older people.
On Wednesday, Senate leaders also released a repeal-only plan. It’s unclear — even to most Republican senators — which order the bills will head to a floor vote, or whether either of them will head to the floor at all.