Bill Still Guts Health Care for Low-Income Kids & Older Adults, While New Provisions Nix Critical Protections for Pre-Existing Conditions
RALEIGH (July 13, 2017) — Today, U.S. Senate Republican leadership unveiled a revised version of the Better Care Reconciliation Act (BCRA). Unfortunately, the latest version is only cosmetically different from the previous BCRA. This BCRA would still end the Medicaid program as we know it, revive discrimination against people with pre-existing conditions, send deductibles skyrocketing, result in plans offering bare-bones coverage, reduce women’s access to health care by stripping Planned Parenthood of Medicaid reimbursement, and make coverage in general less affordable for many North Carolinians.
In addition, a new amendment would reintroduce explicit discrimination against people with pre-existing conditions along with the sale of junk policies that offer bare-bones coverage. This amendment would segment the market, as lower-risk patients select cheap plans and older adults and people with pre-existing conditions seek out more robust and now much more expensive coverage—creating a de facto high risk pool. As this adverse selection continues, premiums would spiral out of control for more expensive patients who need comprehensive coverage, particularly for middle-class North Carolinians with pre-existing conditions who make too much to qualify for a subsidy under the new plan but would be denied coverage under a skimpy plan.
This amendment would destabilize the individual insurance market under the guise of providing consumer choice. But for aging North Carolinians and those with chronic and pre-existing conditions, the choice would be between paying sky-high premiums for coverage and making their rent or mortgage payment; between incurring major medical debt to afford their prescriptions and putting food on the table; and between drawing down on their savings to meet their deductible and saving for their children’s education.
Other changes designed to offset cuts to financial help do not go far enough.
- Allowing consumers to use health savings accounts to pay insurance premiums would disproportionately benefit higher-income earners, doing little to make insurance affordable for consumers with low and moderate incomes.
- Offering a little more money to states for stabilizing premiums—especially when the state has to contribute a significant match up to 35 percent—does not offset the massive cuts made to both Medicaid and subsidies that hundreds of thousands of North Carolinians rely on to afford their private plans.
- No revisions in the bill help low-income North Carolinians afford their deductibles, which under the Senate plan will likely average above $6,000 a year.
- Throwing a little money to states to address the opioid epidemic would not compensate for the draconian cuts to Medicaid, bare-bones plans not covering substance use disorder treatment, and millions of newly uninsured Americans unable to access the care they need.
The Congressional Budget Office found the previous iteration of the BCRA would leave 22 million Americans uninsured and gut Medicaid by cutting funding by 35 percent. While we do not yet have a score for the latest version, it is clear that this bill fails the test put forward by Senator Thom Tillis: the Better Care Reconciliation Act is nowhere close to being a “net improvement” over the Affordable Care Act.
Like the previous iteration of this bill, as well as its companion passed by the House, Republican lawmakers have drafted this bill behind closed doors, without any public hearings, expert testimony, or input from their colleagues across the aisle.
The Senate would be wise to change course, as 71 percent of Americans would rather see a bipartisan effort to improve the Affordable Care Act. Republicans and Democrats can easily come together with some simple short-term improvements, including guaranteeing payments to insurers for cost-sharing reductions that the Trump administration has threatened to withhold. This alone would lower 2018 rates for Blue Cross Blue Shield plans in North Carolina by 14.1 percent.