Senate Federal Healthcare Bill
There has been significant media coverage on the Senate Healthcare Bill (also known as the Better Care Reconciliation Act) which was released on Thursday, June 22, 2017. Media attention has been given to key components such as MediCaid reform, tax credits, and the waiving of essential elements of the Affordable Care Act (ObamaCare).
Who Wins, Who Loses with Senate’s Health Care Bill?
| Affordable Care Act (Obamacare) | House Bill:
American Health Care Act |
Senate Draft:
Better Care Reconciliation Act |
| Individuals Under Age 26 | ||
| Can get insurance through a parent’s plan or buy independently | Stays the same. | Stays the same. |
| Adults Under 65 | ||
| Can buy insurance on health exchanges, with tax credits and subsidies if they meet income requirements up to 400 percent of poverty level. Cost of insurance is based on tobacco use and age, with the people nearing 65 paying no more than three times what the youngest pay. Premiums cannot cost more than 9.5 percent of income. Those with very low or no income qualify for Medicaid | Will see tax credits to pay premiums based on age, not income, and that max out at $4,000, much less than under the ACA. The oldest people under 65 can be charged five times more than the youngest, and maybe more depending on state rules. Medicaid cut after 2020. | The oldest people under 65 would pay five times more than younger people. Subsidies to help pay for insurance would end at incomes of 350 percent of poverty level, with adults 59-64 paying up to 16.2 percent of income. Medicaid would be cut starting in 2021. |
| Low-Income Nursing Home Residents | ||
| Skilled nursing care covered by Medicare up to 100 days. Medicaid is available based on income. | Skilled nursing care covered by Medicare up to 100 days. Medicaid services could be cut as states see federal funding decline | Skilled nursing care covered by Medicare up to 100 days. Medicaid coverage for long-term care could be cut as federal payments to states decline. |
| People With Pre-Existing Medical Conditions | ||
| Coverage cannot be denied or cost more | States can get permission to let insurers charge more for some pre-existing conditions and to exclude some people altogether. States would have access to federal money to help those with expensive policies or conditions | Insurance companies would be required to accept all applicants regardless of health status. But the draft bill would let states ask permission to reduce required coverage, also called “essential health benefits,” which would give insurers some discretion over what they offer in their plans, and possibly change what they can charge consumers. |
| People Who Go to Planned Parenthood | ||
| Federal programs reimburse for most Planned Parenthood services which include care for women’s health, reproductive health, STD testing and treatment, and patient education. | A one-year block will be placed on federal reimbursements for ANY care provided by Planned Parenthood. | A one-year block will be placed on federal reimbursements for ANY care provided by Planned Parenthood. |
| People With Disabilities | ||
| May qualify for Medicare and also Medicaid. | Services covered by Medicaid could be cut as federal funding to states declines over time | Services covered by Medicaid could be cut as federal funding to states declines over time. The cuts would be larger than those in the House bill |
| Working Poor on Medicaid | ||
| Thirty-one states and the District of Columbia offer expanded Medicaid coverage. | Federal funding for Medicaid expansion phases out, potentially affecting millions of people who are currently enrolled under the expansion. | Federal funding for Medicaid expansion phases out between 2021 and 2023. In addition, eight states would have a trigger clause — if the federal matching rate declines below the ACA-promised rates, the expansion goes away immediately. That would affect Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico, and Washington. Further reductions would start in 2025. |
| The Wealthy | ||
| Pay extra taxes to support ACA | The bill would repeal ACA taxes on corporations and cut taxes for the wealthy by about $592 billion | Similar to the House bill; would repeal ACA taxes on corporations and the wealthy that pay for insurance subsidies. |
How would this bill affect those impacted by mental illness?
| Affordable Care Act (Obamacare) | House Bill:
American Health Care Act |
Senate Draft:
Better Care Reconciliation Act |
| Covered by all plans under essential health benefits | Could lose coverage in states that get waivers from covering essential health benefits | Medicaid would not be required to cover mental health after 2019. For other types of insurance, requirements could change in states that request a waiver. |
The Senate’s bill threatens mental health and substance use disorder coverage for all individuals, including children and youth. As written, the bill would cut Medicaid (known as Medi-cal in California) by almost a trillion dollars by cutting back on federal funding over the next decade. These cuts will affect all aspects of health coverage, but it will also have a significant impact on mental health: Medicaid is the single largest payer of mental health services in the country. In California, almost 60% of individuals under the age of 21 are insured through Medi-cal.
Although the Senate bill does protect those with pre-existing conditions, which include mental illness, the plan also proposes to give states the power to waive “essential health benefits” such as mental health and substance use disorder services. The options of waivers has the potential to increase the cost of mental health and substance use disorder services, or eliminate them completely, pushing people with mental health needs to child welfare, emergency rooms, jails, or the streets.
Get Involved!
A vote on the Senate “Better Care Reconciliation Act” is expected on Thursday, June 29th, but could occur before or after that date.
If you are concerned about any part of the plan, contact California’s U.S. Senators, Feinstein and Harris, and let them know your concerns. Their contact information is below:
Feinstein, Dianne – (D – CA)
331 Hart Senate Office Building Washington DC 20510
(202) 224-3841
Contact: www.feinstein.senate.gov/public/index.cfm/e-mail-me
Harris, Kamala D. – (D – CA)
112 Hart Senate Office Building Washington DC 20510
(202) 224-3553
Contact: www.harris.senate.gov/content/contact-senator
Questions? Contact Advocacy@cmhacy.org
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