On Thursday, June 22, Senate Republicans released their version of a repeal and replacement of the Affordable Care Act (ACA). Named the “Better Care Reconciliation Act of 2017,” the bill largely follows the basic contours of the House’s American Health Care Act (AHCA). While more detailed summaries (including a Congressional Budget Office analysis) will be available in the coming days, here are a few of the bill’s key provisions:
- Extends the time to roll back the ACA’s enhanced Medicaid payments. Transforms Medicaid from its current status as an entitlement program to a state choice of per capita payments or fixed block grant allocations. Reduces the rate of growth in Medicaid funding. Early interpretations of these changes describe the Senate bill as making, overall, deeper cuts to Medicaid than the House bill did.
- Reduces cost sharing subsidies available to people purchasing insurance on the individual market through insurance marketplaces or exchanges, including reducing income eligibility for the subsidies.
- Maintains the ACA’s requirement that insurance companies not increase premiums or deny coverage based on preexisting conditions.
- Allows states to change what qualifies as an “essential health benefit” that must be offered by insurance carriers.
- Reduces the funding in the House bill’s Patient and State Stability Fund from $130 billion over 10 years to $112 billion over 10 years. Under the House bill, this fund was designed to help states re-establish high risk pools; under the Senate bill, the fund would be used to reimburse insurers who experience substantial losses.
Assuming that a bill passes both houses and is signed by President Trump, the changes to the ACA as currently proposed by the House and Senate will have significant effects on the Wisconsin health care landscape. Those effects can be expected to extend beyond those immediately receiving their health insurance coverage through an ACA related program. Although Wisconsin did not accept the ACA’s enhanced Medicaid reimbursement rate, a total of 1.2 million people in Wisconsin receive some sort of health care or long-term care coverage under the Wisconsin Medicaid program, including more than 400,000 children and 221,000 low-income seniors and people with disabilities. Approximately 225,000 Wisconsin residents currently purchase insurance coverage on the ACA or Obamacare insurance exchange. In light of the significant role that the Medicaid program and exchange coverage play in Wisconsin’s health care and long term care ecosystem, a diverse coalition including Wisconsin Manufacturers and Commerce, the Metropolitan Milwaukee Chamber of Commerce, the Wisconsin Hospital Association, and many other health care provider associations recently sent a letter to U.S. Senator Ron Johnson, asking him to support adequate cost sharing payments in the insurance marketplaces, and also asking that Wisconsin’s interests be protected as the federal-state Medicaid relationship is transformed by the Congress, specifically by securing additional Medicaid reimbursement for states like Wisconsin that initially passed on the ACA’s Medicaid expansion.
Click here to view a summary of the Affordable Care Act, the American Health Care Act and the Better Care Reconciliation Act of 2017 from The Washington Post.