• The newest provision in the BCRA would start in 2019 and would replace the ACA’s individual mandate, by instead imposing a 6-month delay before new insurance is effective for anyone with a 63-day or longer break in coverage during the past year;
• Elimination of the Medicaid expansion (though slower than the House bill), moving Medicaid to a per capita limit instead of a guaranteed benefit, and changing the indexing to be tied only to CPI growth, not growth in medical spending;
• Repeals most taxes in the ACA;
• Eliminates the employer and individual mandates;
• Forgoes the AHCA age based tax credit structure and builds one more similar to the ACA’s, albeit tied to less rich plans;
• Provides tax credits for individuals below 100% of the poverty level in states that did not expand Medicaid;
• Funds the cost-sharing subsidies through 2019 that help low-income individuals afford their deductibles and out-of-pocket maximums (these subsidies were created by the ACA but their funding is only being provided on a month-to-month basis, creating uncertainty for both members and insurers);
• Allows states to waive Essential Benefits categories, to no longer cover for example maternity care or substance abuse/mental health care; and
• A provision similar to the House bill prohibiting tax credits being used for plans that cover abortion, and also another that defunds Planned Parenthood for a period of time.

The Congressional Budget Office weighed in on this bill on Monday, June 26th. Their assessment was that the bill would:

• Reduce the deficit by $321 Billion over a 10 year period;
• Result in 22 Million fewer Americans having coverage versus if current law were to stay in effect;
• Potentially raise premiums in the short term by about 10%; and
• In 2020 average premiums would be about 30% lower than under current law, in part because older people may be priced out of the market and plans will be allowed to be much skimpier, lowering premiums but requiring higher deductibles and out-of-pocket expenses.

Since the House and the Senate have two different bills on the table, what’s next? Here’s where it gets complicated.

Now that the CBO has scored the bill, the Senate parliamentarian must decide whether all the bill provisions qualify for a budget reconciliation process.  If it does, this would allow the Senate to avoid a filibuster and limit the debate time on the BCRA to 20 hours, at which time a vote would be called.  A simple majority of Senate votes is needed to pass the bill in this instance, and even if there was a tie of 50/50, Vice President Pence would end the tie by voting, most likely, to approve the BCRA.

Once approved by The Senate, the repeal initiative faces more hurdles.  There would still be 2 different versions of the bill: The AHCA from The House and the BCRA from The Senate.  Since the House and the Senate must pass the same exact bill, they may need to consider several revised drafts of the proposal to come to a final consensus.

So here are the next steps:

• The House could decide to vote on and pass the Senate version (BCRA), and Trump could then sign it into law, or
• The House may want to make changes to the BCRA, and they’d request the forming of a conference committee, made up of representatives from each government chamber
• • The Senate could then back down, vote and approve The House version (AHCA), and President Trump would have it on his desk, or
  • If the Senate still disagrees, the formed committee would then debate the bill and may make changes to it; and then
  • • The committee may settle on a final version, which would then be voted upon in the House and Senate.  If both chambers approve it, it goes to President Trump, or if the committee can’t come to a consensus, the bill will die.  

Source: https://blog.ifebp.org/index.php/mapping-out-whats-next-for-health-care-reform

These next steps can take weeks or more, but we’ll be anticipating the latest updates on this hot topic and will be sure to give an update at our July webinar.