ADEA Washington Update

Senate Republicans Move Forward With ACA Replacement

(ACA, Legislation, House, Senate, Medicare and Medicaid Services, Dental Health, Oral Health, Public Health) Permanent link   All Posts


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.[1] 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. 

[1] 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.

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