Senate GOP reveals healthcare bill: 8 things to know

Senate Republicans revealed the discussion draft Thursday morning of their long-awaited healthcare bill, dubbed the "Better Care Reconciliation Act of 2017." 

The BCRA is the Senate Republicans' response to the House version of an ACA repeal bill, the American Health Care Act, which President Donald Trump called "mean." The Senate bill includes a few key differences making it a more moderate repeal and replacement plan than the House proposal. 

Here are eight things to know about the bill and how it differs from the AHCA and ACA.  

1. The bill repeals Medicaid expansion and caps the program. Enhanced funding would be provided to Medicaid expansion states until 2021 and slowly reduced over a three year period, instead of full elimination of the funding in 2020 under the House bill, according to coverage from CNN. The Senate bill would also convert Medicaid funding into a per-capita cap program and offer states the option to apply for funding as a block grant. Additionally, the bill would link the Medicaid growth rate to standard inflation, rather than medical inflation, beginning in 2025, which would reducing the program over time, according to CNN.  

2. The bill restores Disproportionate Share Hospital payment reductions — for nonexpansion states. DSH payments were reduced under the ACA due to Medicaid expansion. The Senate bill includes a provision for "Restoring fairness in DSH allotments," which would restore the reductions to states not considered Medicaid expansion states during a given fiscal year. 

3. The bill repeals nearly all the revenue-generating taxes created under the ACA. The following taxes would be repealed under the Senate bill: the tax on employee health insurance premiums and benefits, the tax on over-the-counter medications, the tax on health savings accounts, the tax on prescription medications, the excise tax on medical devices, the health insurance tax, the chronic care tax, the Medicare tax increase, the tanning tax and the net investment tax.  

4. ACA subsidies to help low-income Americans buy individual coverage would be continued, according to CNN. Where the House bill tied subsidies strictly to age, the Senate bill ties premium tax credits to both age and income. However, the Senate bill would only offer subsidies to those earning up to 350 percent of the federal poverty line, a reduction from the ACA's 400 percent threshold. The Senate bill also bars subsidies from being used on health plans that cover abortion services. Politico reports this provision may be struck down for not following reconciliation rules, which require everything in the bill to have a budgetary effect. 

5. The Senate added $2 billion in funds for substance abuse and mental health programs. This funding would be distributed to states through HHS for fiscal year 2018. Comparatively, the AHCA contained $15 billion in funding for maternity care, substance abuse and mental health services over a decade. 

6. State insurance waivers are more limited in the Senate bill compared to the House version. Unlike the House bill, the Senate's BCRA would maintain the ACA requirement that payers charge the same rates for health plans regardless of health status, according to Politico. However, states are able to opt out of operating an exchange and enforcing essential health benefits requirements, similar to the House bill, according to Politico. The Senate bill, like the House's, also expands the age rating ratio from 3:1 to 5:1, meaning payers can charge older enrollees up to five times more than younger enrollees for the same coverage, according to an analysis from the Committee for a Responsible Federal Budget. 

7. Cost-sharing reduction subsidies would continue until 2019. The repeal of these payments will begin in 2020. The CSR subsidies were created to help payers on the exchanges offset the cost of providing discounted deductibles to low-income enrollees. Extending them until 2019 "will placate insurers," CNN reports. Under the House plan, CSRs would have been eliminated entirely, according to CRFB. 

8. The Senate aims to vote on the bill as early as next week. After the Congressional Budget Office turns around a score of the bill's budgetary effects next week, Senate Majority Leader Mitch McConnell, R-Ky., expects the bill to go to the chamber floor for a vote. Senate Republicans are using a special budget reconciliation process to avoid a Democratic filibuster of the bill. This process allows the bill to pass with a simple majority, or 50 votes. Fifty-two Republicans currently hold seats in the Senate. 

 Editor's note: This article was updated at 2:00 p.m. CT on June 27, 2017 to clarify that the BCRA premium tax credits are tied to both age and income. 

More articles on leadership and management:

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Poll: 35% of voters support House-approved AHCA
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