On June 22, Senate leadership released a discussion draft of their Obamacare “repeal-and-replace” bill, the Better Care Reconciliation Act. A detailed summary of the bill is below, along with possible conservative concerns where applicable. Where provisions in the bill were also included in the reconciliation bill passed by Congress early in 2016 (H.R. 3762, text available here), differences between the two versions, if any, are noted.
Of particular note: It is unclear whether this legislative language has been fully vetted with the Senate parliamentarian. When the Senate considers budget reconciliation legislation—as it plans to do with the Obamacare “repeal-and-replace” bill—the parliamentarian advises whether provisions are budgetary in nature and can be included in the bill (which can pass with a 51-vote simple majority), and which provisions are not budgetary in nature and must be considered separately (i.e., require 60 votes to pass).
In the absence of a complete bill and Congressional Budget Office (CBO) score, it is entirely possible the parliamentarian has not fully vetted this draft—which means provisions could change substantially, or even get stricken from the bill, due to procedural concerns as the process moves forward.
Revisions to Obamacare Subsidies: Modifies eligibility thresholds for the current regime of Obamacare subsidies. Under current law, households with incomes of between 100-400 percent of the federal poverty level (FPL, $24,600 for a family of four in 2017) qualify for subsidies. This provision would change eligibility to include all households with income under 350 percent FPL—effectively eliminating the Medicaid “coverage gap,” whereby low-income individuals (those with incomes under 100 percent FPL) in states that did not expand Medicaid do not qualify for subsidized insurance.
Clarifies the definition of eligibility by substituting “qualified alien” for the current-law term “an alien lawfully present in the United States” with respect to the five-year waiting period for said aliens to receive taxpayer-funded benefits, per the welfare reform law enacted in 1996.
Changes the bidding structure for insurance subsidies. Under current law, subsidy amounts are based on the second-lowest silver plan bid in a given area—with silver plans based upon an actuarial value (the average percentage of annual health expenses covered) of 70 percent. This provision would base subsidies upon the “median cost benchmark plan,” which would be based upon an average actuarial value of 58 percent.
Modifies the existing Obamacare subsidy regime, by including age as an additional factor for determining subsidy amounts. Younger individuals would have to spend a smaller percentage of income on health insurance than under current law, while older individuals would spend a higher percentage of income. For instance, an individual under age 29, making just under 350 percent FPL, would pay 6.4 percent of income on health insurance, whereas an individual between ages 60-64 at the same income level would pay 16.2 percent of income on health insurance. (Current law limits individuals to paying 9.69 percent of income on insurance, at all age brackets, for those with income just below 400 percent FPL.)
Lowers the “failsafe” at which secondary indexing provisions under Obamacare would apply. Under current law, if total spending on premium subsidies exceeds 0.504 percent of gross domestic product annually in years after 2018, the premium subsidies would grow more slowly. (Additional information available here, and a CBO analysis available here.) This provision would reduce the overall cap at which the “failsafe” would apply to 0.4 percent of GDP.
Eliminates the so-called “family glitch,” which renders members of a worker’s family ineligible for insurance subsidies if the worker qualifies for “affordable” employer-sponsored health insurance, regardless of whether said coverage applies to a worker’s family. (Additional information available here.) Also modifies definitions regarding eligibility for subsidies for employees participating in small businesses’ health reimbursement arrangements (HRAs).
Increases penalties on erroneous claims of the credit from 20 percent to 25 percent. Applies most of the above changes beginning in calendar year 2020.
Beginning in 2018, changes the definition of a qualified health plan, to prohibit plans from covering abortion other than in cases of rape, incest, or to save the life of the mother. Some conservatives may be concerned that this provision may eventually be eliminated under the provisions of the Senate’s “Byrd rule,” therefore continuing taxpayer funding of plans that cover abortion. (For more information, see these two articles.)
Eliminates provisions that limit repayment of subsidies for years after 2017. Subsidy eligibility is based upon estimated income, with recipients required to reconcile their subsidies received with actual income during the year-end tax filing process. Current law limits the amount of excess subsidies households with incomes under 400 percent FPL must pay. This provision would eliminate that limitation on repayments, which may result in fewer individuals taking up subsidies in the first place.
Some conservatives may be concerned first that, rather than repealing Obamacare, these provisions actually expand Obamacare—for instance, extending subsidies to some individuals currently not eligible, and fixing the so-called “family glitch.” Some conservatives may also be concerned that, as with Obamacare, these provisions will create disincentives to work that would reduce the labor supply by the equivalent of millions of jobs. Finally, as noted above, some conservatives may believe that, as with Obamacare itself, enacting these policy changes through the budget reconciliation process will prevent the inclusion of strong pro-life protections, thus ensuring continued taxpayer funding of plans that cover abortion.
I rarely make comments as I prefer to read comments and stay in the back ground. That said, the healthcare screw up has forced me to join the conversation. I have been emailing my Reps to no avail, or a response. I am angry that the new healthcare plan still exempts Congress and their staff. Why? I thought Congress worked for us? I am angry that people who lost Insurance coverage due to loss of job, loss of full time status or loss of employee sponsored insurance and therefore could not self pay the high premiums and deductibles will be punished by a massive up front fine ( equivalent to one year of what would have been the total of deductible and premiums) before they can apply for coverage. This is insane as it will keep these hard working people off insurance until they show up in the ER and go on charity care. They should have a grace period to allow people to sign up with out a fine, and I pray the premiums and deductibles will be manageable. I am angry that the so called subsidies were a bunch of malarky. I am angry that all the talk of erasing state lines to lower premiums and create competition has dried up. I have been proactive writing Ryan, my reps and even tried to email the White house all with out a response. The middle class does not have a voice, but they sure love the sound of our taxes and fines pouring into their bank accounts. If I have misstated anything, please correct. I welcome your response.
@Belle: They voted themselves so much power, with non healthcare, who really thought they would ever relinquish it. We are being lied to again, can I purchase any type of health insurance I want? Or must it conform to what they say is best for me. Of course they are exempt.
Thank-you, Kitt. The catharsis of my rant was short lived. I have been without insurance since Jan 2016. The company I work for stopped all insurance and made all of us part time. I could not afford insurance as all the Exchanges used my previous year’s salary / tax return to base payments and deductibles. As I pick up every hour I can, I make too much for subsidies but I never know if I will get hours. Now, the new plan has me paying, as I understand it, an up to $30K fine for not having insurance. Too young for medicare as I am 61. Not crying, just explaining my situation, Kitt. Thanks for your response.
Judicial Watch Asks Trump Administration to End Congressional Obamacare Exemption
JUNE 23, 2017
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(Washington, DC) – Judicial Watch requested the Trump administration stop members of Congress and their staff from unlawfully purchasing, with taxpayer subsidies, health insurance through the District of Columbia’s small business exchange. The Judicial Watch request was made on June 14, 2017, to the Centers for Medicare Medicaid Services (CMS) as part of a process set out by the Department of Health and Human Services to reform the Patient Protection and Affordable Care Act (ACA), otherwise known as Obamacare. http://www.judicialwatch.org/press-room/press-releases/judicial-watch-asks-trump-administration-end-congressional-obamacare-exemption/
@Belle: I can’t read all those negatives into the bill. Maybe because it doesn’t apply to me. Seems as if anyone making less than 87,000 is eligible for a subsidy (350 x 25000). I can’t find any level that calls for a 30K fine. The maximum penalty under Obamacare is $2085 for a family, and is based on a percentage of your income with that as a cap (2085) so I think your statement, that there is going to be a penalty of 30K under Trumpcare is false as I believe all mandates are being removed. Maybe you are just getting your information from a site that I can’t find.
Since you have not had insurance, under Obamacare for over a year, it’s quite evident that Obamacare was not working for you, so something had to be done. Now you will have the opportunity to buy your insurance without being fined if you don’t and a more reasonable rate.
Redteam:This is the link given to me by my friend. I see it says 30% penalty.
@Belle: Thanks for that link Belle. It clearly says that under the Repub bill there will be NO penalty for not signing up for insurance. No persons will be required to buy any insurance that they do not want. That is the millions of persons that the liberals are screaming will be without insurance. But bear in mind. They will not have insurance because they choose to not have insurance. They will not be required to not be covered, or to be covered. They will be able to use their own minds to decide what is best for them. I’m betting that as people drop coverage, insurance companies will compete, by lowering prices, to get them back.
Here is the first statement from that link:
RedTeam: Thanks for clearing that up. I plan to copy and share at work . You’ve made a lot of folks breathe a sigh of relief.
@Belle: Sure thing, your comment caused me to really look at the health care bill to see what is in it. It is best not to just believe what people are saying. It certainly has some things in it that will need to be improved, but it is far superior to what Obamacare has in it. It is important to the country to get it passed, to get rid of Obamacare and start to make the improvements needed. Obamacare is so far off, it essentially can’t be changed to anything that would be acceptable.
I agree, Redteam. Hope they can get the bill passed.
@Redteam: Mad Mad Max strikes again http://americanlookout.com/rms-maxine-waters-700-billion-people-will-lose-insurance-under-trump-video/
Makes you wonder if her and Popeyed Pelosi are competing for the stoopid award.
I do like Trumps tweet, just repeal the and work on replace later.
One reason the GOP health bill is a mess: No one thought Trump would win
That is, We were just telling voters whatever they wanted to hear to get elected, because nobody thought we would actually have to make good on any of it.
@Greg: That link is to the Washington Post and I’m not a subscriber (thank goodness) if you want us to read what some libtard wrote, you’ll have to cut and paste it onto this site. Is there anything true in it?
It wasn’t what some “libtard” wrote, it was what a Republican Senator said:
The “situation” being In a position to actually do something, rather than just talking about it. The inevitable question that follows on that situation is, Why aren’t you?
A guide to the language of the ‘alt-right’, so “snowflakes” will have some idea what the babbling is about.
The rumor, spread by some,, is that they didn’t expect Trump to win.
What is ‘alt-right’? is it opposite to ‘alt-left’. Isn’t that the group that wants communism and/or socialism? Are you a member of the alt-left.?