BCRA & Iowa Hospitals
After passing in the United States House of Representatives in early May, the American Health Care Act (AHCA) to repeal and replace most of the Affordable Care Act (ACA) made its way to the Senate. Rather than voting on the AHCA, the Senate released a revised version of the bill called the Better Care Reconciliation Act (BCRA) on June 22. Senators will likely vote on the BCRA in mid- to late-July, giving the public a short window of time to share their opinions on this proposed legislation with elected officials if they choose to do so.
Learn more about this legislation and analysis of it from the Iowa Hospital Association (IHA).
Quick Facts
Below are some facts to assist you if you choose to reach out to legislators to communicate your position on the bill. Also, visit the “AHCA & Iowa Hospitals” section of this webpage for additional information.
- According to the Congressional Budget Office (CBO), under BCRA, 22 million people would lose coverage by 2026 — 15 million of whom would be Medicaid recipients.
Medicaid
The CBO estimates the bill would reduce federal funding to the Medicaid program by $772 billion from 2017 through 2026, a 26% reduction in 2026 compared to current law.
- Children make up 51.1% of Iowa’s Medicaid population per the American Academy of Pediatrics.
- Per the American Hospital Association, one in 10 veterans depends on Medicaid.
- Nearly two-thirds of Medicaid spending goes to nursing home care.
- BCRA looks very similar to AHCA, but would make extensive changes to the Medicaid funding structure. Instead of federal matching funds, it would give states a set amount to spend per person, which shifts the cost of healthcare to the state, local governments and providers. This could be devastating for the Medicaid program—hitting all hospitals, but especially rural facilities, hard.
Coverage Changes
- Eliminates individual and employer coverage mandate penalties.
- Includes a six-month waiting period if enrollees haven’t had continuous coverage throughout the prior 12 months.
- Allows states to more easily waive essential health benefits, which includes maternity and newborn care, mental health services and more.
Changes in Health Insurance Markets
- Cuts financial help to those who purchase health insurance on the individual market by modifying eligibility for premium tax credits to those who earn 0-350% of the poverty line.
- Changes the age-rating rules to allow insurers to charge older Americans five times as much as younger people.
- Reduces the tax credit available to older adults.
Effect on Hospitals
- The bill does not restore hospital reimbursement rates, which would create substantial financial hardship when combined with the possibility of millions of uninsured Americans.
- Commonwealth Fund estimates the reduction in federal spending on healthcare in the AHCA, which are comparable to the BCRA, would result in 725,000 fewer healthcare jobs and 924,000 fewer total jobs by 2026.
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