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  • Washington Highlights

    CBO Releases Estimates of BCRA Coverage and Cost; Senate Delays Vote

    Jason Kleinman, Senior Legislative Analyst, Govt. Relations

    The Congressional Budget Office (CBO) June 26 released an estimate of the Senate’s health care bill, the Better Care Reconciliation Act of 2017 (BCRA), which would dramatically restructure Medicaid financing, modify the premium subsidies, and eliminate enhanced federal funding for Medicaid expansion over a three year period, among other provisions [see Washington Highlights, June 23].

    According to the CBO’s estimates, the BCRA would increase the number of people who are uninsured by 22 million over ten years compared to projections under current law. The BCRA also would reduce federal Medicaid spending by $772 billion over ten years, while 15 million people would lose Medicaid coverage over the same time period. Based on the CBO’s projections, the BCRA would decrease federal deficits by $321 billion over the 2017-2026 period, which is over $200 billion more than the House-passed American Health Care Act (AHCA, H.R. 1628) [see Washington Highlights, May 26].

    In response to a request from some Senate Democrats, the CBO June 29 released a report on the longer-term effects of the BCRA on Medicaid spending. This report finds that Medicaid spending under the BCRA would be 26 percent lower in 2026 than it would be under the agency’s extended baseline, with the number increasing to 35 percent in 2036. The report notes that the decrease in funding would lead states to make difficult choices, including “… to decide whether to commit more of their own resources, cut payments to health care providers and health plans, eliminate optional services, restrict eligibility for enrollment, or adopt some combination of those approaches. Over the long term, there would be increasing pressure on more states to use all of those tools to a greater extent.”

    Due to opposition from several moderate and conservative senators, Senate Majority Leader Mitch McConnell (R-Ky.) June 27 announced that the Senate would delay its plan to vote on the BCRA until after the July 4 congressional recess. It is expected that Senate Republicans will continue to rewrite the health care bill over the recess period and receive a new score from the CBO.

    The AAMC joined other higher education associations on a June 27 letter to Sen. McConnell (R-Ky.) and Minority Leader Charles Schumer (D-N.Y.) to express concerns about the impact of the BCRA. In addition to highlighting the bill’s impact on student access to health coverage, the letter also details the impact of the Medicaid cuts on state budgets, which may result in states choosing between providing health care for their vulnerable residents and investing in higher education.

    The letter also examines how the Medicaid cuts could impact teaching hospitals and academic medical centers. According to the letter, “the proposed Medicaid cuts and program changes, as well as changes affecting individual market coverage, will also have a significant adverse effect on academic medicine and teaching hospitals, which serve as critical safety net providers and are central to the future of health care in our country.”