The new draft of Senate Majority Leader Mitch McConnell’s Better Care Reconciliation Act released today has significant additions that have seemingly responded both to the demands of his own Republican conference and to public outcry.
As my colleague Russell Berman notes, perhaps the most significant change—or the most significant potential change—over the previous version of the BCRA is the addition of the Cruz amendment, which would allow insurers that provide at least one comprehensive plan on the exchanges to offer barebones plans alongside them that would also qualify for tax credits. That provision is as of yet still bracketed, which means that it is a tentative addition—or deletion—to the final bill. In the same vein, the new BCRA would also allow people to receive tax credits for catastrophic coverage and use health-savings accounts to cover premiums. States would also still retain the ability to waive certain essential benefits from otherwise qualifying plans.
In the aggregate, those tweaks to the exchanges are the largest shift in the new BCRA. Policy-wise, the move seems likely to create some roadblocks: The loss of the individual mandate and the addition of low-premium, high-deductible catastrophic and barebones plans seem likely to disrupt markets, increase their overall risk, and reduce affordable options for people with pre-existing conditions. It would split off the risk pool of low-cost healthy adults who can get by on barebones coverage from the pool of sicker, older adults—which would increase the odds of state exchanges entering death spirals. And it’s unclear if the Congressional Budget Office will even count super-minimal insurance coverage as proper “insurance coverage” per se, which means that this plan could increase the amount the federal government spends providing credits for insurance, without increasing the number of people who count as covered.