Repealing and replacing the Affordable Care Act hasn't been as easy as Republican lawmakers hoped. The American Health Care Act, which narrowly passed the House on May 4, led the way for the Senate's Better Care Reconciliation Act (BCRA), a bill that the Congressional Budget Office estimated will cause an additional 22 million Americans to lose health insurance; allowed states to apply to reinstate lifetime caps and reduce essential benefits like maternal care and ambulance services; and drastically cut funding for Medicaid, which provides prenatal care for nearly half of families, and healthcare for more than 35 million children in the U.S.
Several Republican senators spoke out against that version of the BCRA—and only 17 percent of Americans polled supported it. And moms have been protesting how the bill will impact their families and their children, by visiting their Senators' offices, dressing as Handmaids in protest, and speaking out on social media. And so Senator Mitch McConnell worked for the past few weeks to create a plan that he hoped could pass muster—and the Senate.
So what's different in this new version of the healthcare bill? Two tax cuts for the wealthiest Americans have been taken out of the bill, and an additional $182 billion over 10 years has been put toward helping reduce the financial burden of healthcare for low-income Americans, though the subsidies the ACA currently provides to help low-income and middle-class Americans afford healthcare will end in two years. People will be allowed to use tax-incented healthcare savings accounts to pay for premiums.
The Senate has also earmarked $45 billion to help with the nation's opioid crisis—though healthcare experts say that number is woefully low to address the issue. "The additional money to address the opioid crisis is insufficient," says Julius Hobson, a health care lobbyist with Polsinelli in Washington, D.C., who was formerly the Director of Congressional Affairs for the American Medical Association. "And this is grant money, not automatic spending—they will have to appropriate that money every year."
One part of the bill, the Cruz Amendment, allows states to provide bare-bones coverage in a separate pool, which is cheaper and doesn't cover the essential health benefits from the ACA, such as maternity care or preventative care visits. Critics of that amendment are concerned that it puts people with preexisting conditions like asthma and high blood pressure into a separate pool, which may price their policies so high that people may be unable to find affordable coverage. And in fact, a study released by the nonpartisan Kaiser Family Foundation suggests that 1.5 million Americans will face steeply higher premiums under the Cruz Amendment.
While we wait for the updated CBO score, experts believe the changes to the bill will still result in millions of people losing healthcare coverage. "When you increase the number of people uninsured, there's nothing positive about it," Hobson says. "In the end, it will be about what the CBO says—they need to bring [the number of additional uninsured people] down below 22 million."
That's the big question in Washington right now. Many medical organizations and patients rights advocates—including the American Academy of Pediatrics, the American Medical Association, the March of Dimes, the American Academy of Family Physicians, and the American Congress of Obstetricians and Gynecologists—continue to fight against this bill, which they say will take healthcare away from millions of families. "I worked for the American Medical Association for 13 years, and we rarely agree with insurers about anything," Hobson says. "Here you have a bill, where you have every provider group—physicians, nurses—all the patient groups, all the hospitals, all the insurers against it. I think that's probably not a good thing."
Many families have shared their stories of how this new bill could impact them—and protests continue at lawmakers' offices. But already, two senators—Rand Paul of Kentucky and Susan Collins of Maine, have said that they cannot vote for either version of the senate bill—and there's been no official word from the other eight senators who opposed the earlier version. (And all 48 Democratic and Independent senators have already come out against it.)
Have an opinion on the latest version of the BCRA? You can share it with your senators by calling 202-224-3121.