The Senate Republicans’ revised health care bill will keep Obamacare’s taxes on high-income Americans in place and allow the sales of bare-bones health insurance plans that wouldn’t pass muster under the Affordable Care Act, according to a summary of the bill obtained by Vox.
The bill will include a provision based on a proposal by Sen. Ted Cruz (R-TX), which allows health plans to offer skimpy coverage options so long as they have at least one plan that covers a robust set of benefits. The insurance industry opposes the policy, calling it “infeasible” and fearing it would create “greater instability.”
The new bill is also expected to include an additional $70 billion to offset insurers’ bills for high-cost patients, in addition to $112 billion in the original bill. It will also allow individuals to use tax-advantaged health savings accounts (HSAs) to pay their health insurance premiums, and for the use of tax credits to purchase catastrophic coverage plans.
This summary document was provided to Vox by a lobbyist and its veracity confirmed by two other sources in the health industry. Senate aides did not immediately respond to a request for comment.
Below is the outline of the proposed changes in the revised draft. You can read Vox’s explainer of the original bill here.
Revisions to the Better Care Reconciliation Act
After extensive consultations across the Senate Republican Conference, below are the primary revisions to the Better Care Reconciliation Act (BCRA) discussion draft:
More help to cover out-of-pocket costs
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.
Health Savings Accounts to pay for premiums
In order to ensure that more people have financial support to pay for health care costs, a provision has been included in the bill that would, for the first time, allow people to use their HSAs to pay for their premiums. This is a policy that the Joint Committee on Taxation says will increase health care coverage.
Additional resources to combat the opioid epidemic
With the opioid crisis hitting Americans in every state, an additional $45 billion is dedicated for substance abuse treatment and recovery.
More options for Americans to buy lower-premium plans
Individuals who enroll in catastrophic plans would be eligible for the tax credit so long as they meet other tax credit eligibility requirements. Obamacare prohibited individuals enrolled in catastrophic plans from receiving a tax credit even if they met all other eligibility requirements. Anyone in the individual market would be allowed to purchase a lower-premium health insurance plan, including Americans with their federal tax credit assistance. 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.
Tax revisions
The new draft bill will not include any changes from current law to the 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
To allow for more accurate Disproportionate Share Hospital (DSH) related decisions and maximum benefit to states to assist in providing uncompensated care, the new draft discussion changes the DSH calculation from per Medicaid enrollee to per uninsured.
To improve management of vulnerable populations, states may apply for a waiver for the purpose of continuing and/or improving home and community-based services for aged, blind, and disabled populations. If a public health emergency is declared, state medical assistance expenditures in a particular part of the state will not be counted toward the per capita caps or block grant allocations for the declared period of the emergency. Expanded block grant option to allow states to also add expansion population under the block grant if they opt to do so.
Enhanced focus on higher-risk individuals
Creates a fund for the purpose of making payments to specified health insurance issuers for the associated costs of covering high risk individuals enrolled in the qualified health plans on the Affordable Care Act’s Individual Exchange. In order to qualify for such funds, an issuer must offer sufficient minimum coverage on the Exchange that remains subject to Title 1 mandates. Offering such coverage would enable the issuer to also offer coverage off the Exchange that would be exempt from certain Title 1 mandates.