You’ve probably heard by now that the Senate released the Better Care Reconciliation Act (BCRA) on Thursday. The bill is designed to repeal and replace the Affordable Care Act, aka Obamacare, and it's Senate Republicans' follow-up to the House of Representative's American Health Care Act (AHCA). The bill, which was drafted behind closed doors by just a few Republican lawmakers including Senate Majority Leader Mitch McConnell, was the Senate’s answer to the House version, which was wildly unpopular with the general population and which would result in 23 million more people losing insurance by 2026.
President Donald Trump called the House version of the AHCA “mean” during a lunch with Republican senators in June, a source told CNN, and White House press secretary Sean Spicer said during a press conference on Tuesday that the president “clearly wants a bill that has heart.” Well, he didn’t get it: Senate Minority Leader Chuck Schumer called the Better Care Reconciliation Act even “meaner” on Thursday, per Politico.
Health care expert Leonard Fleck, Ph.D., a professor of philosophy and medical ethics at Michigan State University, tells SELF that the Senate version of the bill is “80 to 90 percent the same as the House version.” For example, both eliminate the mandate that employers with 50 or more full-time employees provide health insurance to their workers, per the Committee for a Responsible Federal Budget. They also both allow states to drop many of the essential health benefits the Affordable Care Act required insurance companies to cover, like maternity coverage, emergency care, and mental health treatments.
The Better Care Reconciliation Act would make even deeper cuts to the program, which uses state and federal funds to provide health care to low-income people and those with disabilities, along with other vulnerable populations. It currently covers more than 70 million Americans. At the same time, the BCRA would create tax cuts for wealthy Americans.
Former president Barack Obama said as much on Thursday. “The Senate bill...is not a health care bill. It’s a massive transfer of wealth from middle-class and poor families to the richest people in America,” he wrote on Facebook. “It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else…. Millions of families will lose coverage entirely.”
Four Republican senators have already said they won’t vote for the bill, which means it lacks the majority votes needed to pass. That said, Republicans are rushing to call a vote before the July 4 recess, meaning senators may not have time to thoroughly debate and hear feedback from their constituents before deciding where they stand. So if enough senators change their minds and the bill passes, it will be a “complete, unmitigated disaster," Sarah O'Leary, founder of Exhale Healthcare Advocates, tells SELF. “The American people are, quite literally, in grave danger.” This is especially true for those on Medicaid.
The new bill makes huge cuts to Medicaid—at least $880 billion over the next 10 years. One of the ways it's doing this is through putting Medicaid on a "per capita cap" system, in which the government would give states a lump sum for each enrollee, or using block grants, aka fixed amounts of federal money given to each state. Either of these would be a huge pivot away from Medicaid's current open-ended entitlement, which means states get more federal funding if health care demands go up.
The Affordable Care Act expanded Medicaid in an effort to help more Americans have access to health care. Under the BCRA, this expansion of Medicaid funding would be kept in place until 2021, but then quickly phased out over the next three years, Dr. Fleck says. “But the bottom line is the same: About 14 million individuals who now have insurance coverage (and decent coverage) through Medicaid will be uninsured in 2024,” he says. This delay pushes bad outcomes into the future so that Republicans can get re-elected and creates uncertainty among voters now as to whether they’ll be negatively impacted one day.
The Senate version also increases federal funding for Medicaid at the rate of medical inflation until 2025 and then switches it to grow with economy-wide inflation after that. That sounds OK, but Dr. Fleck points out that there’s a big difference in those numbers: This year, the economic inflation is expected to increase by less than 2 percent, while medication inflation is thought to rise by 6 percent. “This has been the pattern for the past 40 years—a large gap between those two,” Dr. Fleck says. As a result, money from the federal government into Medicaid will decrease, while states have to try to figure out how to make up the difference—if they do at all.
Then, states might reduce payments to doctors and hospitals, forcing them to choose who to care for and to what extent, and many rural or semi-rural hospitals will be forced to close because they serve a disproportionately large Medicaid population, Dr. Fleck says.
If passed, the health care bill would create different individual plans at various price points, which sounds good on paper. In theory, you could pick and choose a plan based on your needs and financial ability. But with Medicaid funding shrinking, more Americans will be forced to purchase low-quality plans (if they can afford them at all), which won’t provide them much coverage.
As a result, people may delay seeking care or avoid getting it until they’re very sick to try to prevent a large medical bill. The bill “will kill people, and the senators who drafted it know this,” O’Leary says. “The most at risk are those on Medicaid.”
The bill also plans to bar the use of Medicaid funds at health care clinics that also provide abortion services, like Planned Parenthood, which services the reproductive needs of many low-income Americans. Pregnancy rates will rise as a result, O’Leary predicts. Thanks to reduced Medicaid funding, many of those families won’t have health insurance coverage, and child illnesses and death rates could rise.
The bill essentially creates a domino effect for all Americans, O’Leary says. If it becomes law, the poor and working class won’t be able to access or afford health care, so ERs will become their primary care physicians. And, as you probably know, ERs are expensive, but they’re also required to treat patients even if they can’t afford to pay their hospital bills.
“The hospitals can't afford taking those losses, so they’ll begin to charge those patients who can afford to pay much more for their care in a fraudulent practice known as ‘balance billing,’” O’Leary explains. “The wealthy, who feel ‘untouchable,’ will be sideswiped with medical bills for themselves and loved ones who cannot afford the escalating prices of their care.”
This can impact the economy as well. “Medical debt is the number one reason for personal bankruptcy in the United States, and it’s about to become far worse,” O’Leary says. “And when people are without money, they cannot invest in our economy. Health care providers will take a hit. Insurers will take a hit. It’s an economic disaster waiting to happen.”
This bill was drafted by 13 Republicans—and all of them men—during closed-door meetings. Mid-term elections are happening next year, and lawmakers don’t want to lose their seats. O’Leary recommends calling and writing to your senators to voice your opinion, as well as taking to social media to express your thoughts.
Dr. Fleck agrees, recommending that people also demand more time on this bill, which is being rushed to a vote. “The secrecy that has surrounded this whole process is essentially unjust and anti-democratic,” he says. “I cannot imagine any Republican not vigorously objecting if Democrats had done anything similar.”
Related:
- I Have a BRCA Gene Mutation and the AHCA Scares the Hell Out of Me
- 5 Ways the GOP's Health Care Plan Is the Opposite of Pro-Life
- The CBO Estimates the AHCA Will Leave 23 Million More People Uninsured by 2026
Watch: "I Have a Pre-Existing Condition": Real People Share Their Health Conditions in Response to the AHCA
