The Senate’s uphill climb continues for the Better Care Reconciliation Act (BCRA). Since returning from recess on July 4, the Senate has entertained new amendments and discussions of provisional changes thought to help the bill pass. The latest amendments introduce provisions to stabilize the marketplace, introduce choice and increase funds to help low income individuals. The provisions include the following:
- Allow insurance carriers to offer non-ACA (Affordable Care Act) compliant plans to provide individuals with more choice.
- Pro: Without coverage mandates, existing plan options at lower price points may match the needs of individuals, allowing them to select what they want.
- Con: Requiring less coverage may mean individuals will give up needed coverage in order to pay a lower price.
- Permit individuals to use health savings account (HSA) funds to pay premiums.
- Pro: Individuals with high-deductible, HSA-compatible plans would be permitted to pay premiums with tax-free dollars. Employer-sponsored high-deductible, HSA-compatible plans already offer this option for participating employees.
- Con: This option may not be realistic for low income individuals since, by nature, HSA-compatible health plans have high deductible and out-of-pocket requirements that work well only if the individual is able, and chooses, to contribute to the bank account to offset these amounts.
- Added funding options to provide an additional $45 billion over 10 years to diagnose and treat substance abuse and retain the ACA-imposed net income investment tax and Medicare tax increase for higher income individuals.
- Pro: Additional funding to combat the opioid crisis and keep current taxes on the wealthy to help fund tax credits for low income individuals.
- Con: Funding may not be enough to achieve the subsidization necessary for the next two years or until an alternative is implemented.
Senators Rand Paul (R-KY) and Susan Collins (R-ME) remain in opposition after the debate last week. If all Senators vote along party lines, the Republicans would need only to lose two votes to pass the bill.
The Congressional Budget Office (CBO) must score the bill with the new provisions before a vote can take place. To pass the bill, all Senators need to vote. Thought to be released yesterday, the date of the vote is delayed pending John McCain’s recovery from surgery, which at the time of writing, is unknown. Senator Majority Whip, John Cornyn, has confirmed that a vote will take place once they have a full contingent of Senators.
With the fiscal year ending September 30, the Senate is running out of time to take action on this budget reconciliation before beginning work on the next action. Congress has committed to budget reconciliation for tax reform.
In the interim, there have been a few legislative items of note. The Republican reform agenda includes a three-tiered approach. The first is to use budget reconciliation to repeal the financial components of the ACA. The second is to relax ACA regulatory and administrative rules. The third is to pass supporting legislation through the regular process to support the market and environment.
Four bills have passed through the House and now sit at the Senate waiting for consideration:
- H.R. 2581 – Verify First Act – requires individuals receiving premium tax credits to provide their social security number as a condition of receiving the credit
[The act establishes the information necessary to verify eligibility for premium tax credits at the time of application rather than discovering at a later date and trying to recoup credits paid to ineligible individuals.]
- H.R.2372 – VETERAN Act – ensures veterans are eligible for premium tax credits unless enrolled in a veteran’s health program
[Ensures veterans are not disqualified from premium tax credits simply because they are veterans but only because they are enrolled in other minimum essential coverage.]
- H.R. 2579 – Broader Options Act – allows individuals to use their premium tax credits to pay for COBRA continuation coverage
[Creates options for those who may not have individual options in their marketplace or who would rather continue the coverage from their previous employer to eliminate the need to change hospitals and doctors.]
- H.R.1215 – Protecting Access to Care Act – creates medical malpractice reform, including limitation of non-economic damages, fees, future awards, etc.
[Litigation and settlements for medical malpractice increases the cost of medical goods and services to the consumer as the medical provider raises costs in response to the high expense they may incur for potential future settlements and damages.]
Whether the bill is repealed, new bills are passed or a combination of the two, we will continue to see Congress and the regulatory agencies improve and stabilize our health care system and marketplace.
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