The Senate Bills
Thanks to the hard work of the disability advocates, the Senate was unsuccessful in passing any health care bill. The following descries the bills proposed by the Senate. Going forward, it will be helpful to recall what the Senate focused on in their health care bills.
Chronology of bills:
- On July 13, the Senate released its second draft healthcare bill (the “Better Care Reconciliation Act (BCRA)”), which sought to repeal and replace the Affordable Care Act “ACA”.
- On July 19, the Senate introduced the Obamacare Repeal Reconciliation Act (the “ORRA”), which focused on a straight repeal of the ACA. Both of these bills have failed.
- On July 27, the Senate has introduced the “Skinny Bill”. The “Skinny Bill” sought to repeal portions of the ACA. It would have also left the door open for significant amendments, which could have resulted in large portions of the ACA being repealed and significant cuts Medicaid. See more on the “Skinny Bill” here.
Overview of the BCRA
Medicaid would be devastated by per capita caps
Like the House bill, the Senate bill contained per capita caps that would have completely restructured the Medicaid program and caused devastating cuts to the critical services on which people with disabilities rely. The second draft of the Senate bill contained the same cuts and caps. That means that the revised bill would have, based on the recent Congressional Budget Office (CBO) score, $772 billion in cuts to Medicaid, and would have cut Medicaid by 35% by 2036, resulting in 15 million people with losing Medicaid. While the Senate bill contained a “carve out” from the cap for “medically disabled children,” see here and here for all the reasons why a carve out would not have protected these kids from cuts and would still have subjected everyone else to huge cuts. In short, both the Senate and House bills would have restructured Medicaid and lead to devastating cuts.
The second draft of the BCRA created a new 1915(l) Home and Community Based Services program (HCBS). It was a four year demo from 2020-2023, with a limited amount of attached funding ($8 billion), meaning only a few states could take advantage of it: the 15 states with low density populations are given priority. However, the bill still cut the enhanced match for 1915(k) Community First Choice program. The new 1915(l) program at best would have assisted a small handful of states’ HCBS programs for a short period of time. It did nothing to address the likely reduction, elimination, and growing waitlists for optional HCBS programs that would have occurred in every other state across the country. And for all states, this demonstration wold have ended as the Senate’s even more restrictive caps kicked in and did nothing to address the estimated 35% reduction in Medicaid funding by 2036. In short, this 1915(l) program is only a fraction of the cut in funding to Community First Choice and did not even make up for the loss of that program’s enhanced match. Bottom line, the second draft contained no improvements. Read the statement from the Consortium for Citizens with disabilities the BCRA here.
Overview of the ORRA
32 million to lose health care coverage
This bill would have been devastating to people with disabilities. The Medicaid expansion (of whom one third of the beneficiaries are people with disabilities) would have come to an end. It also removed the prohibition against denying people with preexisting conditions insurance coverage, and it removed lifetime and annual caps. Under this bill it would be very difficult, if not impossible, for people to receive support in the community with the elimination of the enhanced match for the Community First Choice home and community based services program. In short, this bill would have dramatically altered the care and support people with disabilities need to participate in the community. The bill would also have doubled health insurance premiums by 2026, and would have driven insurers out of the individual market. While millions of Americans would have been facing massive cuts, households with incomes over $1 million would have been granted $50,000 a year in tax breaks under this bill.
Overview of the “Skinny Bill”
The “Skinny Bill” would have repealed three portions of the ACA: the individual mandate, the business mandate, and the medical devices tax. This would have raised health insurance premiums by 20% each year for the foreseeable future, it would have resulted in 15 million people losing health care, and it would have destabilized the health insurance markets. It would have also paved the way for more, significant amendments to the health care bill, which would have included cuts to Medicaid.