Republicans in the Senate recently revealed an updated draft of a plan to repeal and replace the Affordable Care Act (ACA). This new bill, dubbed the Better Care Reconciliation Act (BCRA), is broadly similar to the bill introduced in the House earlier this year. But this 142-page piece of legislation – and a revision released today – has some significant differences as well.
According to HHS Secretary, Tom Price, the proposal “is built on patient-centered reforms that put the American people back in charge of their own healthcare decisions.” What are some important facets of this new bill independent physicians should be aware of?
1. Medicaid will undergo fundamental changes with more cuts than the House bill
This new bill plans to rollback the ACA’s Medicaid expansion by maintaining current funding levels for three years before large funding cuts in 2020. These cuts would represent the deepest slashes to Medicaid in its 52-year history. In the years ahead, Medicaid coverage could be cut as the program becomes more expensive for states to operate.
For physicians, cutting back on Medicaid funding has the potential to lead to lower reimbursement rates. Consequently, some physicians might choose to stop accepting Medicaid patients. The program currently covers 1 in 5 Americans, including many with costly and complex health needs.
According to the Georgetown Center on Children and Families, 19 states could be disproportionately affected by the planned spending reductions to Medicaid, with Alaska, Mississippi, Maine and Louisiana topping the list. Medicaid physicians in these states could experience more widespread changes, with nearly 15 percent of seniors in small towns and rural areas in these regions covered by Medicaid.
2. 22 million individuals will be uninsured according to the CBO
The nonpartisan Congressional Budget Office (CBO) announced today that the BCRA could leave an estimated 22 million patients without insurance by 2026, only slightly below the 23 million predicted for the House bill. Nearly 15 million more individuals would be uninsured compared to the ACA.
A large portion of this predicted decline in coverage will come from the new bill’s Medicaid cuts but some of the Senate bill’s new provisions – such as the mandate that certain employers cover insurance for their employees – means that many individuals with employer-provided insurance could also stand to lose their coverage if this new bill comes into effect.
3. The bill changes the way subsidies for insurance are calculated
One of the more popular provisions the ACA introduced was premium subsidy payments to help individuals afford the insurance coverage they were mandated to obtain by the law. Like the ACA, the House version of the bill determined who is eligible for these subsidies based solely on age but the BCRA also considers an individual’s income and location.
This can reduce costs for younger patients but significantly raise them for older beneficiaries. Older patients could pay for premiums five times as high as their younger counterparts, in place of the three times difference currently allowed.
4. Insurers can sell lower quality insurance – impacting those with pre-existing conditions
Unlike the House bill, the draft Senate bill allows states to ask for permission to reduce the 10 “essential health benefits,” mandated by Obamacare to allow insurers to drop benefits such as maternity coverage, mental healthcare and prescription drug coverage. Insurers could also potentially change what they charge for certain patients.
By allowing for plans that cover fewer health conditions, insurers can sell lower quality insurance. The elimination of the ACA’s insurance rules that help protect millions with pre-existing conditions could mean there would be nothing stopping insurers from providing skimpier insurance or refusing to cover high-cost drugs such as cancer therapies.
5. Patients that have a lapse in coverage could lose coverage for 6 months
Earlier today, Senate Republicans issued a new revision to the newly released bill that would replace the ACA individual mandate for obtaining coverage by penalizing individuals who let their insurance lapse for at least 63 days. Under this revision, these patients would have to face a 6 month delay in their coverage the next time they try to obtain coverage.
This waiting period is meant to encourage healthy people to buy insurance while they are still healthy, instead of waiting until they are sick to do so. This bump in healthy patients is designed to help insurance companies pay for sicker patients who are often more expensive to cover. For physicians, if more patients are incentivized to obtain coverage, preventative care could enable healthier patient populations.
6. Many physicians and medical groups are opposed to the bill
What physician’s groups are saying about the new bill?
The American College of Physicians (ACP), which represents nearly 150,000 primary care physicians is particularly concerned with cuts to Medicaid as it would “reduce reimbursement for healthcare professionals.” The ACP is also concerned with the potential for the bill to make evidence-based preventive services more costly and out of reach.
The American Association of Family Physicians (AAFP) echoed the ACP by saying “the legislation will reportedly reserve its harshest consequences for the most vulnerable among us” and criticized its lack of investment in primary care. The American Medical Association (AMA) believes the legislation violates the medical standard “first, do no harm,” on several levels.
What happens next?
Lawmakers hope the bill will go to a vote before the July 4 recess next week. In the meantime, it’s still unclear whether the bill can pass the Senate and be signed into law. Whatever happens next, Elation is committed to bringing independent physicians the most relevant information as soon as shifts in healthcare occur.