A revised version of the Better Care Reconciliation Act retains significant cuts to Medicaid, despite the protest— and defection—of Republican centrists.
Lawmakers have also decided to keep taxes on the wealthy and insurer CEO compensation, which are projected to bring in $232 billion over the decade. Of that, $182 billion would be directed to states to stabilize their individual insurance markets.
That’s an increase of $70 billion from the original version of the bill. Additional funds from the taxes would be used to link disproportionate share hospital funds to uninsured rates, which will help facilities in states that did not expand Medicaid. The last version of the bill also contained DSH funds in those states, but hospitals said they were a pittance compared to the cuts that would come to Medicaid.
In terms of the Medicaid per-capita cap, the only significant change is that the revision would lift the federal spending cap if there’s a public health emergency. Sen. Mark Rubio, R-Fla., sought that assurance because of Florida’s experience with Zika.
The bill opens the door to selling less comprehensive insurance on the exchanges.
The summary circulating on the Hill Thursday morning says: “Anyone in the individual market would be allowed to purchase a lower-premium health insurance plan, including Americans with their federal tax credit assistance. These plans are higher deductible plans that cover three primary care visits a year and have federal protections that limit an individual’s out-of-pocket costs.”
It would allow tax credits to be used to buy these catastrophic plans. Before the change in administration, catastrophic plans were only allowed for those under 30 with a financial hardship, and credits could not be used to buy them.
The summary is silent on whether it incorporates amendment spearheaded by conservative Sens. Ted Cruz and Mike Lee that would allow insurers to sell less-comprehensive plans off the exchange
“The Cruz-Lee Amendment has not been added to BCRA. Something based on it has, but I have not seen it or agreed to it. I am withholding judgment,” Lee tweeted Thursday morning.