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Why Was the Senate BCRA Vote Delayed?

Why Was the Senate BCRA Vote Delayed?
President Donald Trump shakes hands with Senate Majority Leader Mitch McConnell of Ky., center, before the start of a meeting with House and Senate Leadership in the Roosevelt Room of the White House in Washington, Tuesday, June 6, 2017. (AP Photo/Pablo Martinez Monsivais)

Wednesday, 28 June 2017 04:42 PM Current | Bio | Archive

Tuesday evening, Senate Majority Leader Mitch McConnell, R-Ky., delayed a vote on the Senate Republican’s healthcare bill named the Better Care Reconciliation Act (BCRA). President Trump later tweeted that he met with Republican senators about what needs to be done to get the bill passed. 

So what was in the bill, and which issues caused the delay?

Below is a breakdown of the main points in the bill and how some of those points caused the delay:


Many of the taxes introduced in Obamacare, such as the net investment income tax, medical device tax, pharmaceutical tax, health savings account tax, are repealed under the BCRA. In general, the Senate Republicans are on board for repealing the Obamacare taxes.


The bill would have implemented a Medicaid rollback that would have started in 2021. By 2025 the bill would create a cap on Medicaid payments linked to market inflation rather than health cost inflation. This is where Republicans find their savings to the budget for the reconciliation process. This is one of the more contested aspects of the bill, as Sens. Dean Heller, R-Nev., Rob Portman, R-Ohio, and Shelly Capito, R-W.Va., specifically mentioned changes to Medicaid as their reason for concern.

Pre-Existing Conditions

Insurance companies will be mandated to cover patients with pre-existing conditions. States can no longer obtain a waiver for covering pre-existing conditions, however, they can obtain a waiver for "essential health benefits" such as outpatient, mental health, maternity and emergency room care. This wasn’t necessarily a point of contention as the necessity for a state to obtain a waiver can only be determined by the impacts of the rest of the bill.

Employer and Individual Mandates

The bill removes the employer mandate. It also removes the individual mandate, but a new provision imposes a six-month waiting period before new insurance goes into effect for anyone who had a break in coverage lasting 63 days or longer in the prior year. It would take effect beginning in 2019. In general, the Senate Republicans are on board with these measures.

Subsidies for Insurance Companies

Strangely, the bill includes the same subsidies for insurance companies that the Republicans originally opposed. The party even sued the Obama administration over the subsidies, but they’ve now chosen to make the subsidies an official part of the bill.

Subsidies for Purchasing Insurance

The bill slightly reduces the income level cap for receiving subsidies for insurance purchases. Under Obamacare, a family of four making less than $98,000 would receive subsidies, where under the BCRA that cap would be around $86,000. The only other significant difference is that age will no longer be a factor in calculating a subsidy. GOP senators are generally in favor of this but some may have unvoiced concerns.

CBO Score

The Congressional Budget Office reported that the Senate version of the bill would increase the number of people without health insurance by 22 million by 2026. Before taking that at face value, look at the CBO’s prediction of coverage under Obamacare vs what the actual numbers are today. The CBO’s 2013 score projected that without Obamacare, in 2016 186 million people would be covered by private health insurance. The CBO’s 2016 score of Obamacare calculated that 177 million people were on private insurance. So either the CBO score was wildly off, or Obamacare actually reduced the number of people on private insurance due to its failed framework. That said, the CBO score was the main concern stated by Sen. Susan Collins, R-Maine.

Three Conservative Hold-outs

Sens. Rand Paul, R-Ky., Ted Cruz, R-Texas, of Texas and Ron Johnson, R-Wis., signed a statement last week that expressed their beliefs that the bill didn’t truly repeal the core structures of Obamacare and said that the bill didn’t do enough to reduce the cost of healthcare. Being staunch conservatives, one can expect that they want a bill that reduces the government’s involvement in healthcare.

As the nation waits on the Senate to craft a bill that they can pass, millions of Americans are suffering from massive spikes in premiums, skyrocketing prescription drug prices and ever shrinking choices in insurers. It’s time for the Senate to take action, and that means on both sides of the aisle. Democrats and Republicans need to work together to give all Americans access to affordable and effective plans. Think about the families of America, the grandparents, grandchildren, husbands and wives, the children — these are the people that are suffering and we need to think of them first.

Richard S. Bernstein, CEO of Richard S. Bernstein & Associates, Inc., West Palm Beach, is an insurance advisor for high net worth business leaders, families, businesses, municipalities, and charitable organizations. An insurance advisor to many of America’s wealthiest families, he is a writer, trusted local and national media resource and expert speaker on estate planning and health insurance. Visit his website at www.rbernstein.com. To read more of his reports — Click Here Now.

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As the nation waits on the Senate to craft a bill that they can pass, millions of Americans suffer massive spikes in premiums, skyrocketing prescription drug prices and ever shrinking choices in insurers. It’s time for the Senate to take action, and that means on both sides of the aisle.
bcra, cbo, gop, senate, senators
Wednesday, 28 June 2017 04:42 PM
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