On June 22, Senate Republicans unveiled their Affordable Care Act
(ACA) replacement draft, titled the Senate Better Care Reconciliation Act (BCRA),
which makes deep cuts to Medicaid and
ends the ACA’s individual mandate requiring that most Americans have health
insurance or a pay a penalty fee. The 145-page Senate BCRA creates a new
classification of federal tax credits to help people buy health insurance,
while “sun setting” the 10 essential
health benefits, one of which is pediatric dental
care, on Dec. 31, 2019. The
BCRA also authorizes states to change the amount of premiums for adults, which may
vary due to age, from 3:1 under current law to 5:1 (or a different ratio at
state discretion). This would lower premiums for younger adults and raise them
for older adults in states that made the change.
The Congressional Budget Office (CBO) estimates the BCRA would
leave 22 million more people uninsured by 2026. The House version, the American
Health Care Act of 2017 (AHCA), if enacted
according to the CBO, would leave 23 million individuals uninsured.
Approximately 15 million people would lose health care coverage within the first
year of implementation alone. Since the BCRA also eliminates the employer mandate,
a penalty for businesses of a certain size that do not provide insurance to
workers, the CBO predicts that 4 million individuals would lose
employer-sponsored coverage by 2018.
According to the CBO, by 2026, the number of
people under age 65 without coverage would reach 49 million, compared with 28
million under the ACA.
The CBO stated that low-income Americans in
their 50s and early 60s would be disproportionately more likely to lose their
health care coverage under the BCRA. Although people buying insurance in the
individual market would see lower premiums in many cases, the policies would
cover less, and out-of-pocket costs would be higher.
GOP Sens. Dean Heller of Nevada, Rob Portman
of Ohio, and Susan Collins of Maine, have taken issue with the BCRA, as did
AARP, the American Hospital Association, the American Cancer Society Cancer
Action Network, and the Association of American Medical Colleges. The
Association of American Medical Colleges wrote “We are extremely
disappointed by the Senate bill released today . . . despite promises to the
contrary, it will leave millions of people without health coverage, and others
with only bare-bones plans that will be insufficient to properly address their
needs.” Senate Majority Leader Mitch McConnell (R-KY) is in a difficult
position as he works over the July 4th recess to garner enough
support from his members and health-related organizations.
Assuming no Democrats vote for the bill, and
with only 52 Republicans in the Senate; Sen. McConnell can only lose two
Republican votes and still pass the bill with help from Vice President Mike Pence’s
tie breaking vote. As of June 28, The
Washington Post's Whip Count had 12 Republican senators indicating they
oppose or have concerns with the current version of the bill.
The Senate measure, like the House bill,
phases out the additional money given to states by the federal government as an
incentive for them to expand eligibility for Medicaid. It also repeals most of
the tax increases imposed by the ACA to help pay for expanded coverage, which
ends up cutting billions of dollars from Medicaid, a program that serves one in
five Americans including close to two-thirds of people in nursing homes. A
capital-gains tax cut for the wealthiest Americans would be retroactive to 2016.
Passage of the Senate bill would affect about
one-sixth of our nation’s economy and give President Trump and the Republican-controlled
Congress a major victory. As of June 29, the Senate has postponed the vote on
the BCRA until after the Fourth of July Recess.
ADEA continues to monitor the congressional actions
on health care and will keep members informed of its effect on academic
dentistry and craniofacial research programs.
 The 10 essential health benefits include: 1) Ambulatory patient services;
2) Emergency services; 3) Hospitalization; 4) Pregnancy, maternity, and newborn
care; 5) Mental health and substance use disorder services; 6) Prescription
drugs; 7) Rehabilitative and habilitative services and devices; 8) Laboratory
services; 9) Preventive and wellness services; and 10) Pediatric services,
including dental care and vision care for children.