Just Released: The Senate GOP Leadership’s New Better Care Reconciliation Act (BCRA)

Senate Republican leadership released the updated text of the Better Care Reconciliation Act (BCRA) a short time ago. View the section by section summaries here and here.


In May, the House narrowly passed their replacement plan, the American Health Care Act (AHCA), but the Senate was forced to overhaul the House-passed bill when it became clear that moderate GOP senators were unwilling to move forward with that legislation. The updates made to BCRA are clearly aimed at drawing the support of the most conservative members of the Republican caucus. Below is a brief overview of the changes and next steps for the legislation.


Biggest changes:

  • Inclusion of a version of the Cruz (R-TX) which would allow insurers to sell non-ACA compliant plans as long as they offer at least one plan that meets marketplace requirements. This policy change has been blasted by actuaries, insurers, and providers – but has been made a must-pass priority for conservatives.
  • A Disproportionate Share Hospital (DSH) payment change that would base DSH payments on the number of uninsured people served rather than the number of Medicaid enrollees. This policy change is likely to benefit providers in non-expansion states while hurting those in states that expanded Medicaid.
  • Inclusion of additional financial support to purchase health insurance and allow the use of health savings account (HSA) funds to pay insurance premiums.
  • A tweak to the block grant language that would allow states to count the Medicaid expansion population within the block grant.
  • An exemption of state costs of public health emergencies from Medicaid per-capita caps.
  • A change to Medicaid 1115 waivers to allow states to continue or improve home and community-based services for the aged, blind, and disabled.
  • Keeps some ACA taxes on the wealthy to help offset additional spending on premium assistance.


The Process:

The preferred Leadership timeline for BCRA:
  • Today: release of the updated BCRA text
  • Monday: CBO scheduled to release their score of the updated text
  • Mid-Next Week: vote on Motion to Proceed to debate on BCRA (needs at least 50 votes, with VP Pence as tiebreaker
  • End of Next Week: Debate and vote on amendments and, ultimately, on BCRA (needs at least 50 votes, with VP Pence as tiebreaker). This is the opportunity for moderates to amend the legislation to better protect their states.


Our Health Policy team will be monitoring and providing updates of any new developments. Contact us for more information on how you can get exclusive health care policy and reform updates.


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