A Flurry of Activities this Week around the Senate’s ‘Better Care Reconciliation Act’

Senate Republicans Postpone Vote on ‘Better Care Reconciliation Act’

After releasing the ‘Better Care Reconciliation Act’ (BCRA) late last week, Senate Republicans faced stiff opposition, both from the public and within their party, forcing Senate Majority Leader Mitch McConnell to postpone the vote until after the July 4 Recess. On Monday, the Congressional Budget Office (CBO) released a cost estimate of the BCRA, estimating that the bill would increase the number of people who are uninsured by 22 million in 2026, for a total of 49 million Americans without insurance. With the sobering CBO score and increasing GOP turmoil, the Senate’s proposal to repeal the ACA quickly began to unravel.

McConnell spent the remainder of the week meeting with Republican Senators in an attempt to bridge the gap between moderate and conservative members of his party by offering changes to the legislation. Potential changes have reportedly included increasing opioid prevention spending to $45 billion, allowing pre-tax health savings accounts to pay for insurance premiums, and removing tax breaks for high-income people, yet no legislative language has been released. On Thursday, the CBO issued another analysis of the BCRA detailing the longer-term effects of the proposed legislation, estimating Medicaid spending would be 35 percent lower in 2036.

Despite the attempts to sweeten the deal for some Republican Senators, both factions of the party appeared to be at an impasse as Senators returned to their states on Thursday evening. Latest reports suggest Republican Senators will spend the Independence Day Recess writing new legislation for a vote upon their return to Washington after next week’s recess. President Trump, on the other hand, began advocating Friday that the Senate repeal the ACA immediately and replace it at a later date.

In its released form, the BCRA proposes to eliminate the Public Health and Prevention Fund, roll back Medicaid Expansion, implement Medicaid per capita caps, and eliminate Essential Health Benefits, among other drastic changes. CHEAC included a brief overview of the Senate’s proposal in last week’s update available here and continues to closely follow the ongoing effort to repeal the ACA.

DHCS Releases Analysis on Senate’s Better Care Reconciliation Act (BCRA)

The California Department of Health Care Services (DHCS) released a preliminary fiscal analysis of the BCRA this week, revealing that California could face more than $30 billion annually in additional health care costs by 2027. BCRA would drastically shift costs from the federal government to the State of California, resulting in cumulative costs of $114.6 billion, $92.4 billion of which would be costs to the General Fund, between 2020 and 2027.

Further, the BCRA would quintuple the State’s costs for the more than 3.8 million Californians in the ACA expansion population currently covered by Medi-Cal, resulting in an estimated $74.1 billion in costs between 2021 and 2027. This proposal dramatically reshapes the federal-state partnership of Medicaid and threatens to force California to consider reducing or even ending vital health care services to the state’s most vulnerable individuals, according to the analysis.

DHCS’s analysis and fiscal estimates for the BCRA are available here.

CHEAC Activity

CHEAC signed onto a letter organized by the Trust For America’s Health (TFAH) to Senate leadership opposing the repeal of the Affordable Care Act’s Prevention and Public Health Fund. The Prevention and Public Health Fund supports essential core public health services, including immunization programs, epidemiology and laboratory services, cancer screenings, and chronic disease prevention efforts. The letter, featuring more than 580 signees, is available here.

CHEAC also signed onto a letter this week with a coalition of California county organizations. The letter was delivered to U.S. Senators and is available here.

Members are can find additional ACA-related resources on our website.