One of the more controversial amendments of the bill came from Sens. Ted Cruz and Mike Lee, which proposed allowing insurance companies to offer plans which don’t meet all of the regulations set forth under the ACA so long as these insurers also sell plans which do meet the regulations.
This amendment would allow for healthy people to buy cheaper health insurance plans, but those with pre-existing conditions or sick people would face higher premiums or lose access to coverage altogether.
The CEO of Blue Cross Blue Shield, Scott Serota, said to in a letter that this proposal is “unworkable as it would undermine pre-existing condition protections, increase premiums and destabilize the market.”
While Cruz and Lee say the amendment would give consumers more choice and bring down premium costs, America’s Health Insurance Plans (AHIP) echoed Serota.
“Unfortunately, this proposal would fracture and segment insurance markets into separate risk pools and create an un-level playing field that would lead to widespread adverse selection and unstable health insurance markets,” says an AHIP memo.
This insurer criticism could give moderate Republicans pause, but the Hill reports the Cruz-Lee language will be in brackets, “an indication that it is subject to change or removal.”
Another stipulation in the original version of the Senate bill which left some Republicans nixing their support was Medicaid. According to the Congressional Budget Office, the original bill would leave 15 million fewer people enrolled in Medicaid and cut $772 billion over the next decade.
Like the original, this version of the bill has deep cuts to Medicaid starting in 2025 and an end to the Medicaid expansion funds by 2024. These Medicaid cuts are concerning for a handful of Republican moderates, which is who this new version aimed to get on board. Insurers are also not in favor of the Medicaid cuts.
The new version of the bill tried to address this by adding money to a fund that would lower premiums. In addition to the $112 billion already being allotted to the “stability fund,” the latest BCRA bill tacks on another $70 billion.
While the Hill notes the new bill is largely similar to versions we’ve already seen, here are some newly added provisions:
It scales back tax credits given to people struggling to afford insurance, but does keep the credit in place. This is something on-the-fence Senators wanted to see stay intact.
Adds $45 billion to address the opioid epidemic.
It keeps in place two ACA taxes for the wealthy, which were originally removed in the Senate’s first version of the BCRA.
The CBO is expected to issue a new report on uninsured estimates early next week, and the Senate is expected to take a vote on the bill by the end of next week.
Still, the vote will be tight. The Hill reports Sens. Susan Collins and Rand Paul will mostly likely oppose the new legislation, giving Vice President Mike Pence the tiebreaking vote. However, one more “no” vote and the BCRA won’t pass.