How Would the Health Care 'Plans' Being Debated by Senate Republicans Affect You? - And, How to Make Your Voice Heard

Senate Republicans voted today to open debate on the Floor of the U.S. Senate on various partially understood versions of potential legislation to repeal, or repeal and replace, the Patient Protection and Affordable Care Act (also known as Obamacare).

The vote on a motion to open floor debate resulted in a 50-50 tie vote of all Senators, broken by Vice President Mike Pence’s vote in favor of opening debate. All Democrats, along with Republican Senators Susan Collins of Maine and Lisa Murkowski of Alaska, voted against opening floor debate on these undeveloped legislative proposals at this time.

As late as yesterday and today, Republican Senators have been quoted as saying they had no idea what proposals would be debated or voted on or what is contained in the various “Plans” that may be presented for a vote by Senator Mitch McConnell (R- KY), the Senate Majority Leader (pictured at left)

According to reporting today by Reuters and by Vox, there appear to be three different options that Senator McConnell may be contemplating bringing to a vote:

  1. “Skinny repeal,” a new proposal, which would eliminate the individual mandate, employer mandates, and a medical device tax under the Patient Protection & Affordable Care Act, but take no further action at this time;
  2. A measure that would fully repeal the Patient Protection & Affordable Care Act’s spending and health insurance coverage expansions with no replacement (referred to as the Obamacare Repeal Reconciliation Act, or ORRA); and
  3. “A repeal-and-replace plan that senators have been working on for months (the Better Care Reconciliation Act, or BCRA).”
  4. If any of these proposals were adopted into law, how would they affect you?

    Option 1 – “Skinny Repeal”

    Very little is known about what might be included in such a proposal, apparently being worked on by Senator McConnell behind closed doors. But, lobbyists indicate that Senator McConnell may be contemplating “[e]liminating the penalty for Obamacare’s individual mandate — possibly along with its employer mandate and some of its taxes on the health care industry,” Vox reports.

    The Congressional Budget Office has estimated that repealing the individual mandate under the Patient Protection & Affordable Care Act, alone, would have the effect of leaving 15 million Americans who currently have health insurance uninsured within 10 years from now.

    Insurance industry experts indicate that without requiring relatively healthy younger people to purchase health insurance, to offset the costs of insuring older less healthy individuals, the Health Insurance Marketplace of the Patient Protection & Affordable Care Act would likely collapse, leaving millions more who now have health insurance uninsured.

    Option 2 – Repeal of the Patient Protection & Affordable Care Act with No Replacement

    This option, as previously introduced in the House, is known as H.R. 1628, the Obamacare Repeal Reconciliation Act of 2017 (“ORRA”).

    The nonpartisan Congressional Budget Office has estimated that passing this bill into law would increase the number of uninsured Americans by 17 million in 2018, and by 32 million in 2026. That means that this Republican proposal, by next year, would take health care insurance away from 17 million people who have it today, and by 2026 would take health care insurance away from 32 million people who have health insurance today.

    Option 3 – Repeal and Replace the Patient Protection & Affordable Care Act by Draft Legislation referred to as the “Better Care Reconciliation Act, or BCRA

    The nonpartisan Congressional Budget Office has published a report on this bill, finding that it would “increase the number of people who are uninsured by 22 million in 2026 relative to current law.”

    The nonpartisan Kaiser Family Foundation has published a significant Issue Brief entitled, “How the Senate Better Care Reconciliation Act (BCRA) Could Affect Coverage and Premiums for Older Adults.” It is must-reading for anyone in their 50′s or 60′s – which we know includes most family caregivers.

    Some of Kaiser Foundations findings about the “Senate Better Care Reconciliation Act (BCRA)” include the following:

    • It would “result in an increase of four million 50-64-year-olds without health insurance in 2026;” Specifically, the number of 50-64 year olds without health insurance would increase from 4.9 million to 8.9 million by 2026 under this Republican plan.
    • Lower income adults age 50 to 64 would be most negatively affected. Kaiser reports that “CBO projects the uninsured rate for low-income older adults would rise from 11% under current law to 26% under the BCRA by 2026.”
    • “Under current law, insurers are prohibited from charging older adults more than 3-times the premium amount for younger adults. The Senate bill [the BCRA] would allow insurers to charge older adults five-times more than younger adults, beginning in 2019,” Kaiser reports.
    • For a 64-year-old, the national average premium for an unsubsidized bronze plan in 2026 would increase from $12,900 (current law) to $16,000 (BCRA),” Kaiser reports. Similarly, Kaiser found that the national average premium for an unsubsidized silver plan in 2026 would increase from $15,300 (current law) to $20,500 (BCRA).
    • The amount that lower-income individuals with a subsidy must contribute toward purchase of a health insurance plan would be based on age and significantly increased for older people. Kaiser reports that “under current law, at 350% FPL, individuals are required to contribute the same percentage of income toward the benchmark plan, regardless of age (9.69% in 2017). Under the BCRA, starting in 2020, a 24-year-old would contribute about 6.4% of income, while a 60-year-old would have to contribute 16.2% of income.”
    • Cost-sharing subsidies would be eliminated starting in 2020. As a result people now using tax credits to help purchase health insurance plans would “face significantly higher deductibles under the Senate proposal than under current law,” and older adults will see a significant “increase the out-of-pocket cost for premiums at all income levels.” “For example,” Kaiser reports, “a 64-year old with an income of $26,500 would see premiums increase by $4,800 on average for a silver plan in 2026; a 64-year old with an income of $56,800 could see premiums increase of $13,700 in 2026, according to CBO.” The results would vary geographically, so that “Older adults living in higher cost areas could see greater dollar increases, while people living in lower cost areas could see lower increases.”
    • On average, 55-64 year-olds would pay 115% higher premiums for a silver plan in 2020 under the BCRA after taking tax credits into account. Low-income 55-64-year-olds would pay 294% higher premiums relative to current law,” Kaiser reports.
    • In addition, the BCRA’s proposed drastic cuts to Medicaid “would result in an estimated 15 million people losing Medicaid coverage by 2026 according to CBO,” Kaiser reports.
    • Finally, Kaiser finds that the BCRA may have substantial negative impacts on the strength and longevity of Medicare. The Kaiser report states:
      The loss of coverage for adults in their 50s and early 60s could have ripple effects for Medicare, a possibility that has received little attention. If the BCRA results in a loss of health insurance for a meaningful number of people in their late 50s and early 60s, as CBO projects, there is good reason to believe that people who lose insurance will delay care, if they can, until they turn 65 and become eligible for Medicare, and then use more services once on Medicare. This could cause Medicare spending to increase, which would lead to increases in Medicare premiums and cost-sharing requirements.

    For further information on the BCRA, see the Kaiser Foundation’s report entitled, “Summary of the Better Care Reconciliation Act of 2017″.

    Public Opinion

    Polls show that the Republican proposals are very unpopular with the American people.

    According to reporting by the Washington Examiner, a new poll released by NPR, PBS NewsHour and Marist measuring views on the Republican BCRA shows that “Only 17 percent of Americans approve of Senate Republicans’ healthcare bill.”

    The poll found that only 35 percent of Republicans approve of the bill, and only 13 percent of independents and only 8 percent of Democrats approve of the bill.

    Many Medical Groups, insurers, and other interest groups are actively opposing the legislation. According to reporting by CNN, Groups actively opposed to the Republican legislation include, among others:

    • The American Medical Association
    • AARP
    • American Hospital Association
    • American Association of Medical Colleges
    • American College of Physicians
    • American Academy of Family Physicians
    • American Academy of Pediatrics
    • National Association of Medicaid Directors
    • American Psychiatric Association
    • Federation of American Hospitals
    • America’s Essential Hospitals
    • American Heart Association: “The Senate draft health care bill is literally heartless”
    • American Lung Association
    • The National Center on Addiction and Substance Abuse: “Anyone who votes for the Better Care Reconciliation Act of 2017 cannot claim to be committed to ending the opioid epidemic.”
    • American Cancer Society Cancer Action Network: “​Preliminary analysis of the Senate bill released today shows the proposal could greatly harm millions of cancer patients, survivors and those at risk for the disease.”
    • US Conference for Catholic Bishops: “This moment cannot pass without comment. As the USCCB has consistently said, the loss of affordable access for millions of people is simply unacceptable. These are real families who need and deserve health care.”

    In addition, a group of over 7,000 Catholic Sisters from all 50 states recently delivered a letter to the Senate “urging senators to vote against any bill that repeals the Patient Protection and Affordable Care Act or cuts Medicaid,” according to the National Catholic Reporter. See Don’t repeal, don’t reduce the ACA, say US sisters.

    How to Make Your Voice Heard

    If you are among the majority of Americans who disapprove of the Republican plans to repeal or to repeal and replace the Patient Protection & Affordable Care Act (also known as Obamacare), you can make your voice heard in time to have an impact on this legislation.

    Here are a few resources to help you contact your Senators and Congressmen to voice your concerns:


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