Reaction to the Senate’s version of an Affordable Care Act repeal-and-replace plan, titled the Better Care Reconciliation Act (BCRA) ranged from strong opposition from physician and hospital groups to outrage from Democrats, while one insurance organization saw some positives in the legislation.
The bill, which builds off the House-passed American Health Care Act (AHCA), makes far-reaching changes to health coverage. It would begin rolling back Medicaid expansion in 2020, reducing its funding to per-capita allotment based on overall inflation, rather than medical inflation, in 2025, unless states opt for block grants. States would be allowed to waive ACA insurance requirements like what benefits must be covered, the medical-loss ratio and rebate rules. As in the House bill, BCRA would also eliminate most of the ACA’s taxes and mandates, including the individual mandate penalizing people who choose not to purchase insurance.
As they did with several versions of the AHCA, almost all healthcare industry groups came out against the legislation.
“The Senate proposal would likely trigger deep cuts to the Medicaid program that covers millions of Americans with chronic conditions such as cancer, along with the elderly and individuals with disabilities who need long-term services and support,” said American Hospital Association President and CEO Rick Pollack. “Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance. We urge the Senate to go back to the drawing board and develop legislation that continues to provide coverage to all Americans who currently have it.”
One by one, groups released statements bashing the proposal. The American Society for Radiation Oncology (ASTRO) said it would “create undue financial burdens” on cancer patients." Regarding the cuts to Medicaid, the American Academy of Pediatrics (AAP) said to its members: “We cannot let this happen.” The Children’s Hospital Association called it a “bad bill for kids.” America’s Essential Hospitals said the Senate put “ideology ahead of lives,” and called the closed-door process in crafting the bill a “slap in the face to the democratic process.”
Democrats, as expected, were uniformly opposed to the bill. Even former President Barack Obama weighed in, calling it not a healthcare bill, but a “transfer of wealth from middle-class and poor families to the richest people in America.”
The bigger concern for Republican leaders, however, is opposition from within their own caucus. If three Republican senators vote against the bill, it won’t pass, and four—Sens. Rand Paul, MD, R-Kentucky, Ted Cruz, R-Texas, Mike Lee, R-Utah and Ron Johnson, R-Wisconsin—have come out against it in its current form because they feel it’s not a true repeal of the ACA.
"Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor," they said in a joint statement.
Five other senators—Susan Collins of Maine, Lisa Murkowski of Alaska, Dean Heller of Nevada, Rob Portman of Ohio and Shelley Moore Capito of West Virginia—are on the opposite end of the spectrum, concerned about the severity of Medicaid cuts in the bill.
One bright spot for the bill’s supporters may come from insurance groups. While the industry’s largest lobby, America’s Health Insurance Plans, has been publicly silent on the Senate bill, the Alliance of Community Health Plans (ACHP) offered some tepid support for the BCRA.
“We appreciate that the Senate has funded the vitally important CSR subsidies through 2019 and is providing some amount of market certainty,” said ACHP President and CEO Ceci Connolly. “We also appreciate consideration of tax credits based on income and geography and will evaluate their ability to sufficiently provide affordable coverage.”
The BCRA could be brought to a vote in the Senate before the end of June. The next step will be the Congressional Budget Office’s report on the legislation, which is expected on June 26 or 27.