Congress promised a new and improved version of the American Health Care Act passed by the House. But did the Better Care Reconciliation Act really deliver?

By Lisa Milbrand
June 23, 2017
Mitch McConnell and President Trump healthcare bill
Credit: Mark Wilson/Getty Images

When the House of Representatives passed the American Health Care Act (AHCA) in May, it was hugely unpopular with most healthcare organizations and most Americans—fewer than 10 percent of Americans favored the bill, which threatened to make healthcare unaffordable again for millions of Americans, and reduce coverage for millions more. The Senate was expected to make changes to improve the bill, and 13 Senators worked in secret to put together the new plan, the Better Care Reconciliation Act. The new bill was shared yesterday, and it appears that many of the biggest concerns with the AHCA haven't been changed in the Senate version.

So how will the new bill affect you, if it passes through Congress? Here's what you can expect:

• Many Americans will lose health coverage. The Congressional Budget Office (CBO) projects that the May House bill would end up causing 24 million additional Americans to lose their healthcare within the next decade. The CBO scoring on the current bill will be released early next week, but the two bills are similar enough to expect a comparable number of people to lose their healthcare.

• Many Americans will pay more for coverage. The new bill cuts back on the subsidies the government pays to help make insurance policies more affordable for families, and cuts off the help at a lower income bracket. Under the Affordable Care Act (AKA the ACA or Obamacare) a family of four that makes $97,200 per year would receive at least some assistance paying for their health insurance, but the Senate bill will cut off help for families making more than $85,050. And the bill also increases the percentage of health insurance you have to pay before they kick in their share—the nonpartisan Kaiser Family Foundation estimates that costs for health insurance for lower-income Americans who qualify for subsidies will increase by 15 percent in the new plan.

• And they will receive less for what they pay. The new bill also lowers the bar on the level of insurance you receive for that amount of money: The ACA pays for a mid-level (silver) plan that covers 70 percent of your healthcare costs, while the new Senate bill will cover a bronze plan that covers 58 percent of your healthcare costs. So that means some families will pay more for health insurance that covers less of their costs.

• You will no longer be required to keep health insurance. Obamacare imposed penalties for people who chose not to pay for health insurance, and the Senate bill removes that penalty.

• If you or a loved one relies on Medicaid for healthcare or nursing home care, they could face significant cuts in their care. This is perhaps the biggest cut of all in the Better Care Reconciliation Act. The bill is similar to the American Health Care Act, in that it is expected to cut hundreds of billions of dollars in healthcare for the low-income Americans—the AHCA was projected to cut $834 billion in funding over a decade. Medicaid is responsible for a large swath of services, including covering nearly half of all U.S. births and approximately 65 percent of nursing home care in the U.S.  The American Academy of Pediatrics released a statement expressing its deep concerns about the impact of this particular cut on the nation's children. "The bill fails children by dismantling the Medicaid program, capping its funding, ending its expansion and allowing its benefits to be scaled back," the statement says. "The bill fails all children by leaving more families uninsured, or without insurance they can afford or that meets their basic needs. This bill fails children living in or near poverty, children in foster care and children with complex health care needs whose parents have private insurance – all of these children depend on Medicaid, and if this bill passes, Medicaid will no longer be there for them."

• You will no longer be guaranteed maternity care, hospitalization, or other essential health benefits. After 2019, American health coverage no longer has to provide "essential health benefits" that were guaranteed under the ACA. That means your state could apply for a waiver so that health insurers in that state no longer have to cover things that are guaranteed under the current plan—including maternity care, prescription drugs, hospitalization, mental health services, or no caps on coverage.

• People who have preexisting conditions will be charged the same amount for health insurance as healthier people, but there are other ways that their coverage could be denied. The House bill allowed states to apply for waivers so insurers could charge more for coverage if you had a preexisting condition—but the new bill will no longer allow that. However, because states can still apply for other waivers—including ones that would allow insurers to place lifetime or annual caps on coverage, or allow them to stop covering prescription benefits—people with preexisting conditions may find themselves exceeding their cap, or being unable to get insurance coverage that pays for expensive prescriptions.

• Government programs that fund public health and safety initiatives will be cut. The Prevention and Public Health Fund, administered by the Centers for Disease Control, provides public health funding for things like immunizations and cancer screenings, and programs to prevent bioterrorism and fight disease outbreaks. The Better Care Reconciliation Act cuts the $1 billion used to fund that program, a move that the former head of the CDC told The Washington Post would be devastating. "Americans will be at greater risk from vaccine-preventable disease, food-borne infections, and deadly infections contracted in hospitals," says CDC’s former director, Tom Frieden.

• Planned Parenthood will lose federal funding for at least one year. While controversy surrounds Planned Parenthood's abortion services, the bulk of its work involves providing essential healthcare services for women, including cancer screenings, prenatal care and other preventative care, often to women who can't otherwise afford it. Federal funds will no longer be able to be used for services there.

• As you get older, your health insurance costs will grow significantly. The new bill allows insurers to charge customers more as they age—and older people can be charged five times more than younger people for the same policy.

• There's a tax break for everyone—but especially for the wealthiest Americans. The Tax Policy Center estimates that families who are in the lowest tax brackets will save nearly $150 per year on their tax bill, while those in the top 1 percent of income will receive a hefty $37,320 tax break.

What do you think of the changes? You can let your senator know by calling the Capitol switchboard at (202) 224-3121.