The “Better Care Reconciliation Act” released by the Senate Majority today is anything but better.  It will degrade health coverage for everyone, and deprive it altogether from millions of Americans. In fact it appears to be worse than the American Health Care Act passed by the House last month.

America’s modern health system has been built around employer-sponsored health insurance.  According to Forbes, 170 million Americans receive health coverage through plans sponsored by their employers. The BCRA will require most of those 170 million to pay more for worse health care coverage, by eliminating requirements for essential health benefits, allowing states the option of instituting life time caps and charging higher premiums to those over 50. In fact it eliminates the requirements for large employers to even offer health coverage and makes it impossible for small businesses to afford decent coverage if they so desire.

Medicaid is a safety net for those who are still suffering from the recession, have lost their jobs, or have low paying jobs without benefits. In the Central Valley, for example, the oil and agriculture industries have dropped tens of thousands of jobs in the past decade, and these families have no choice but to rely on Medicaid as they search for new work or training opportunities.

Children in low-income families – nearly one of every two children in the US – and people with disabilities also depend on Medicaid, which is funded in partnership between the federal government and state governments. In all, 65 million Americans are covered under Medicaid, including 37 million children; in California, Medicaid covers 14 million people, including 1.4 million children.

BCRA cuts $800 Billion from Medicaid, and these drastic cuts will force states to kick millions off the program.  California stands to lose over half of its in federal funding for Medicaid ($15 billion (58%)), which would be impossible to backfill with tax increases and will mean millions will lose insurance.

Many people may not be aware that Medicaid is what allows seniors to access long-term care without imposing a burden on their families, on their children, and grandchildren. According to AARP, about 65 percent of nursing home residents are supported primarily by Medicaid, and Medicaid pays for 45 percent of the total nursing home bill.  With block grants or per capita caps, it is our parents and grandparents that will suffer.
BCRA’s cuts likely would lead to severe financial hardship on millions of families, including having to quit work to care for elderly parents, and risk losing their own health coverage and financial security.

And for low-income children, the BCRA’s proposed Medicaid cuts would be a disaster. 95 percent of children in America now have health insurance coverage, 97 percent in California. In California, we’ve gone from 1.2 million uninsured kids down to less than 100,000. More than 37 million children are enrolled in Medicaid, compared to 1 million in the health exchanges set up under the Affordable Care Act. There simply is no way to shield our nation’s most vulnerable children from Medicaid cuts of this magnitude.

The BCRA violates President Trump’s promises on the campaign and in office not to cut Medicaid, and his promise after inauguration to “come up with a new plan that’s going to be better health care for more people at a lesser cost.” The BCRA’s devastating block grants and per capita caps upon the Medicaid program are harsher than even the House bill, which President Trump himself referred to as ‘mean.’  We agree.  The Senate’s decision to exempt disabled children from imposed caps only highlights how harmful BCRA is to kids. Per capita caps and block grants are bad for everyone.. This bill asks low and middle-income people (and their employers) to spend more for less coverage, and makes it impossible for states to respond to population growth, epidemics, medical advances and treatment, or emergencies like earthquakes and fires.

As damaging as the bill’s substantive provisions are, the Senate has been reckless and irresponsible in handling such a vital, life and death issue. The Affordable Care Act, which the BCRA is meant to dismantle, was debated in three House committees and two Senate committees, and was subject to hours of bipartisan debate that allowed for the consideration of 130 amendments from both sides of the aisle. The BCRA is likewise a major piece of legislation, yet it was drafted in secret, with none of the Senates’s “regular order” of committee hearings and processes. In 2009, the full Senate debated the health care bill for 25 straight days before passing it on Dec. 24, 2009.  We expect 20 hours of debate total on this bill.

The BCRA will not not produce better care for anyone; instead, it will destabilize the health insurance markets, including private insurance sponsored by employers; cause risk pools to be older and sicker; cause uncertainty for hospitals and health systems across the country; require middle- and low-income families to pay more for worse coverage; and kick millions of people off insurance altogether. This is bad policy, plain and simple.

Written with Judy Darnell, Vice President for Public Policy, and Danielle Kilchenstein, Health Coverage Project Administrator