On June 22, the Senate’s healthcare bill, the Better Care Reconciliation Act of 2017 (BCRA), demonstrated that the Republicans’ goal is to target Medicaid and close the avenues through which lower income Americans can access healthcare.
Impact on Medicaid
- The Senate bill aims to cut the Medicaid expansion beginning in 2021, while cutting the remaining of the program’s budget overall. In California, the federal Medicaid expansion spending totaled $18,973,833,500 in FY 2015 alone. Without this funding for the state will struggle to fill that void thus causing, 3.7 million Californians to lose healthcare coverage. According to several analyses of BCRA, by 2024, the proportion of individuals with Medicaid insurance would be reverted to the pre-Obamacare status quo.
- The BCRA would restructure the Medicaid program by creating a per-capita cap or block grant, which would give each state a fixed amount to spend per person rather than the current open-ended funding commitment. For the first time since the creation of Medicaid in 1965, the federal government would no longer match each state’s spending for the program. In California, Medi-Cal covers 42% of all children under the age of 18 and 50% of all births. Additionally, seniors and people with disabilities comprise 15% of the Medi-Cal population. Cutting funds would unfortunately force state policymakers to choose between providing healthcare to children, seniors, and people with disabilities, and other priorities such as education, food security programs, and infrastructure.
Impact on the Marketplace
While the BCRA maintains the framework of the individual marketplaces, it does change vital protections that would make health insurance coverage less accessible to low- and middle-income Americans.
- Subsidies for buying insurance would be dramatically decreased for less generous health insurance plans with higher deductibles. Currently financial assistance is provided to those earning 400% of the federal poverty line (FPL), BCRA would provide assistance to anyone earning less than 350% of the FPL. In California, marketplace enrollees received an estimated $408,455,000 (February 2017) in annual premium tax credits. Overall, fewer individuals would be eligible for a federal subsidy which would cause a financial hardship on millions of sick Americans who will be expected to contribute more of their income to pay for their healthcare.
- States would be allowed to opt out of essential health benefits (EHBs) and the marketplace altogether. This could allow states to seek exemptions from covering services such as maternity care, mental health, and emergency care.
Favors the wealthy over the poor
The BCRA aims to cut taxes for the wealthy. The Affordable Care Act includes a tax increase to wealthy individuals and corporations in order to help pay for the expansion of care. However, under the Senate draft of the bill, these taxes for the wealthy and corporations would be repealed by about $592 billion.
Overall, the bill favors individuals who are healthy and wealthy, while creating drawbacks for those who are sick and poor, which will leave tens of millions of lower-income Americans without insurance. Both the House and Senate versions of the healthcare bill aim to cut federal healthcare spending, cap Medicaid, and shift greater financial burden to the states. Most importantly, both plans will cause more Americans to lose healthcare coverage and struggle to pay for medical bills. Thus, each of the proposed Obamacare replacement plans is a direct attack on Americans most vulnerable: those who are sick and poor. We cannot make America great by pushing communities further into poverty.
Healthcare Bill Comparison
| Affordable Care Act | House AHCA | Senate AHCA |
| Medicaid as an entitlement program with open-ended, matching federal funds for anyone who qualifies. | Per capita amount or block grant based on state’s current spending in order to decrease federal funding. | Per capita amount or block grant beginning in 2021. The amount would grow more slowly than in the House bill, meaning bigger spending cuts overall. |
| State Medicaid expansion to cover folks making up to 138% of FPL | States not allowed to expand Medicaid after 2017. Federal funding would be reduced to states that do expand by the deadline. | Federal government would pay a smaller portion of Medicaid expansion starting in 2021. |
| Essential Health Benefits (EHBs) | States decide what qualifies as an EHB. | States decide what qualifies as an EHB. |
| Planned Parenthood eligible for reimbursement under Medicaid, but federal funds cannot be used for abortions. | Planned Parenthood would face a one-year Medicaid funding freeze. | Planned Parenthood would face a one-year Medicaid funding freeze. |
| Individual Mandate | 30% penalty for allowing coverage to lapse | No individual mandate |
| Employer mandate | No employer mandate | No employer mandate |
| Individuals under 26 years of age can remain insured in their parent’s health insurance | Remains | Remains |
| Tax credit formula based on income, age, and geography | Tax credits based mostly on age | Tax credits based on age, income, and geography to cover a skimpier plan, and income threshold would be reduced. |
| Premium cannot be raised based on preexisting conditions | States would be allowed to increase premiums based on preexisting conditions if person has a break in coverage. | Premiums cannot be raised based on preexisting conditions |
| Older customers can be charged 3 times more than young customers | Insurers would be able to charge older customers 5 times more than younger customers. | Insurers would be able to charge older customers 5 times more than younger customers. |
| No high-risk pools due to other protections | States would receive $130 billion over 10 years for high-risk pools. | Stability fund of $112 billion over 10 years to reimburse insurers who take big losses. |
| Chart modified from “What the Senate bill changes about Obamacare” by the Washington Post, 6/22/2017. | ||
We know that different forms of social inequality and environmental deprivation have detrimental consequences to people’s health, and we must keep fighting against bills such as this and other proposals that would hurt communities of color and low-income individuals. Now, more than ever we must join against this and all other attacks that create further disparities and prevent vulnerable communities from being able to lift out of poverty. We are fortunate in California to have two Senators that support our most vulnerable communities. Encourage your friends and family members in other states who are not so lucky to contact and urge their Federal Senators to not pass this detrimental bill.
CHC staff will continue to monitor this and other efforts to repeal the Affordable Care Act. We will provide updates as they are unveiled.