Healthcare: Take 2 in the Senate


So what’s the new plan? Prior to the 4th of July recess, Leader McConnell delayed the vote on the Better Care and Reconciliation Act (BCRA), which would get rid of the “individual mandate” implemented by the Affordable Care Act (ACA) and cap funding for Medicaid, among other major provisions. The bill includes tax credits that help people pay for coverage which are tied to income, instead of just age. It also removes taxes on high-income Americans that help pay for the ACA. However, it keeps the “stay on your parents’ plan until you’re 26 years old” rule and the rule that says insurance companies can’t charge people more if they have pre-existing conditions. A lot of people didn’t like version 1, so today, Leader McConnell revealed BCRA 2.0 in an attempt to reach 50–the magic number of votes it would take to pass this legislation through the Senate. This new language includes an unpopular amendment from Sen. Ted Cruz (R-TX), an original opponent of version 1.

BCRA 2.0 (via the Senate Committee on the Budget):

  • Out of Pocket: An additional $70 billion is dedicated to driving state-based reforms, which could include help with driving down premiums through cost-sharing, Health Savings Accounts (HSA), and other innovative ideas to help pay for health care costs. This is in addition to the $112 billion in funding already in the original bill.
  • Heath Savings Accounts for Premiums: A provision has been included in the bill that would allow people to use their HSAs to pay for their premiums.
  • Resources for Combating Opioid Epidemic: $45 billion is dedicated for substance abuse treatment and recovery.
  • Skeleton Plans: Individuals who enroll in catastrophic plans would be eligible for the tax credit subject to eligibility requirements. These plans are higher deductible plans that cover three primary care visits a year and have federal protections that limit an individual’s out-of-pocket costs.
  • Taxes: Does not include 3.8% net investment income tax, the additional Medicare Health Insurance (HI) Tax, or the remuneration tax on executive compensation for certain health insurance executives.
  • Medicaid Revisions: Disproportionate Share Hospital (DSH) changes the DSH calculation from per Medicaid enrollee to per uninsured.
    • Public Health Emergency Funds: Will not be counted toward the per capita caps or block grant allocations for the declared period of the emergency.
    • Expanded Block Grant Option: States will be allowed to add the expanded Medicaid-eligible population under the block grant if they opt to do so.
  • High Risk Population: Payments could be made available to specified health insurers covering high-risk individuals enrolled in the qualified health plans on the Affordable Care Act’s Individual Exchange.

What do the Democrats think? Yesterday, in anticipation of the release of BCRA 2.0 the House Democrats introduced their answer to healthcare reform.

“A group of House Democrats has produced its own healthcare reform proposal to improve upon the nation’s healthcare system shaped over the last 7 years by the Affordable Care Act (ACA). The New Democrat Coalition’s Affordable and Accessible Health Care Task Force has come up with the Solutions Over Politics plan to build upon the healthcare infrastructure put in place by the ACA. This plan would include an annual $15 billion reinsurance fund to pay for high-cost enrollees, continue the ACA’s cost-sharing reduction payments, increase outreach to boost enrollment in marketplace plans, implement a Medicare buy-in option for older Americans not yet eligible for Medicare, expand premium tax credits to help individuals pay insurance premiums, and expand the availability of catastrophic health plans to encourage younger, healthy people to buy coverage.” (via The Hill)

What does ANA think? We still don’t like it.

hc-3What happens next? The CBO will evaluate Version 2.0 and release a score on Monday. The CBO’s report will assess the impact of the new bill and predict how much it will cost or save the Federal Government. In the past, this hasn’t gone so well. The Senate is expected to vote on the bill soon (if Leader McConnell can rally the votes).

What are WE doing and what can YOU do? ANA will continue to urge the Senate to #ProtectOurCare. If you haven’t done so already, be sure to call your Senator and remind them to put patients first!

3 thoughts on “Healthcare: Take 2 in the Senate”

  1. 32 years I have watched and cared for my patients on possibly one of the worst days of their lives. I am an Emergency Trauma RN/CEN. This country is capable of providing excellent care to all of our patients! We must own the ACA and fund it. Please let us stand behind health coverage for all; not just those who can pay for it! Our patients are your family, friends and commmunity. Americans deserve good medical care not what these current proposals will take away. I care! Please do not vote for the GOP proposal . Health care is for all. All people need coverage ; I know, I see them daily at my work.

  2. Thank you ANA for all your information on the new Health Care bill. Thank you for looking out for Patients (and providers) best interests. The elephant in the room that is grossly overlooked by the ACA AND THE NEW REVISED HEALTHCARE PROPOSAL is that the American healthcare systems will never be “affordable” until the entire insurance structure is changed. The insurers such as Humana, Anthem, United Healthcare and ETNA are raping Americans by maintaining a “disease-care” insurance industry that profits from keeping people sick. This is a sick system for sure.
    Until we get rid of third party insurers and create a system of direct pay for services without grossly inflated prices that are then “negotiated” by insurers to providers, the “healthcare” industry remains the biggest scam in our lifetime. I personally support catastrophic health care insurance (similar to auto insurance), mandatory healthcare savings accounts (of which each person/family would direct how these funds are utilized) and direct pay for healthcare services. This could save Americans billions of dollars currently going to insurance company profits. The premium money would instead go toward their own healthcare savings accounts. Providers could decrease their costs by 30% not having to participate in the ridiculous game of the insurance companies antics. This is all perfectly described in David Goldhill’s book, “Catastrophic Healthcare: Why Everything We Think We Know About Health Care is Wrong.”

    1. Dear ANA:
      Thanks for all you, ANA, and its leaders have addressed for so many years to attend to “healthcare” of individuals, families, groups, and communities. Somehow, if it could ever happen, it would be nice to have “medical insurance”, which is basically, many, many years, the case and attend to medical treatments, procedures, post-diagnosis, etc, Then, how could we develop a “health insurance” that would address well care, health promotion, disease prevention, well child care, OB care, basic mental health assessments and the like. We, in nursing, have taught and practiced this for more than a century, but such is really not on board, as all has to be “medically necessary” to receive any care. Know this is still an ideal, but that is the work of nurses–to see that basic health and safety needs are met, then see about greater outcomes for all, such being our stalwart ideal. I, for one, am very active in this state working to facilitate insurance enrollment, so that persons have some form of coverage. I learned recently that 68% of our nursing homes residents are on Medicaid, so such reductions in this vein, along with small rural hospitals struggling to survive, need such funds. A’s seem to be the popular word, such as “affordable” health care, much, such as Kim Evans as shared, links to insurance structures. Another key A is accountable and we, a free, enterprising society, must be able to see that health care is Available and Accountable. The most precious unit of any society is its people and the healthier they are, the more productive they are, thus society flourishes. ANA’s voice is crucial ALWAYS, but especially at this time. Getting funds to one’s own Health Savings ACCOUNT, so independence is honored, could help persons and families to place personal ACCOUNTABILITY to self health care. I have been working in nursing for 53 yrs and have seem major innovations by nursing, so getting nursing and health care into the code and funds is imperative. Overtime, such could see reductions in health (really medical) care spending, as initiatives by nurses would be directed to “health” care, ie. promotion, disease prevention, and optimizing best care options. We must see that health care is provided to all.

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