NAFC Initial Summary of the Senate “Better Care Reconciliation Act of 2017’’

Today, the Senate released their Health Care Reform Discussion Draft Legislation titled, “Better Care Reconciliation Act of 2017’’.  

The NAFC staff has read the Senate legislation and with respect to the NAFC’s mission to ensure that the medically underserved have access to affordable health care and our public policy priorities, we see some distinct areas of concern.

The specific areas of concern for the NAFC in the Better Care Reconciliation Act of 2017 are:

  • The phase out over four years of Medicaid expansion, starting in 2021 and ending in 2024.
  • For states that expanded Medicaid, the federal government would pay a smaller portion of the cost starting in 2021.
  • Limitation on Medicaid spending through per capita caps or block grants for states that choose them. The spending growth rate would become stricter in 2025.
  • While the ACA’s tax credits would be kept in place, their value would be dramatically reduced.
  • While the ACA cost sharing subsidies would be funded through 2019, they would be repealed in 2020 and going forward. It should be noted that the Trump administration could end subsides earlier
  • While the ACA tax credits continue in 2018 and 2019, in 2020 they would only be available for people with incomes up to 350 percent of the poverty line versus the current 400% under the ACA.
  • While insurers cannot charge higher premiums to patients with preexisting conditions under the Senate bill, states can still change what qualifies as an essential benefit by applying for a waiver.
  • Insurers would be able to charge older customers up to five times more than they charge younger customers.

Other topics that the NAFC is closely monitoring during the discussion of the Better Care Reconciliation Act of 2017 are:

  • The individual mandate would be eliminated. Nothing would replace it to incentivize healthy people to get insurance.
  • The employer mandate would be eliminated.
  • Young adults could stay on their parents’ health insurance plan until they’re 26 years old.
  • Insurance companies are not allowed to increase someone’s premiums or deny coverage based on preexisting conditions. Since states can still change what qualifies as an essential benefit by applying for a waiver, however, that means people with preexisting conditions could get an insurance plan, but not one that covers what they need.
  • People can contribute more to their health savings accounts than under the ACA.
  • The stability fund would receive $112 billion over 10 years, and would be aimed at reimbursing insurers who take big losses.

The NAFC will continue to work with policy makers to express the needs of patients and our members’ organizations who are providing health care daily in communities across the county. It is our hope that as the Senate continues to discuss this legislation, changes can be made that will allow for a health care system that provides affordable coverage, care and dignity to all. It is our hope that we can work with our policy makers to build a healthy America, one person at a time- together.