Mitch McConnell is determined to push the Republicans' Repeal and Replace bill for a vote next week, by July 21. He needs only 50 Senators to close the deal, because VP Pence will step in to cast the deciding vote to pass it.
The BRCA, as they have named the bill, dramatically changes the ACA. The CBO estimates that 22 million Americans will lose their coverage in the coming years. Here are four main changes:
1. The individual mandate would be abolished under the Senate plan. Without a requirement to buy a policy, many healthy people will go without coverage or buy a new bare bones policy. That means prices will sky rocket for anyone who wants to buy a policy that covers the 10 essential benefits of the ACA. Insurers would prefer that everyone bought a policy, and have advocated for raising the penalty for not purchasing a policy because it wasn't high enough to compel people.
2. Older Americans on the individual market will see enormous premium increases. Currently, insurers are only allowed to charge those aged 50-64 3 times the premium of younger Americans. The BRCA will increase that from 3 to 5 times the premium. If a 20 year old pays $300/month for a platinum plan (current price in LA), an older American would pay up to $1,575/month. That would be $18,900 premium for an individual, $37,800 for a couple - until they qualify for Medicare.
3. Pre-existing conditions would be undermined indirectly, but with devastating consequences. States would be allowed to seek waivers for insurance companies to offer bare bones policies, as long as at least one plan is offered that would cover the essential benefits in the ACA. Many healthy people would go with the cheap, minimal policies, making the market for the essential benefits policy incredibly expensive.
4. Medicaid funding will be dramatically altered to limit its growth in many ways. (1) It would eliminate enhanced funding for Medicaid expansion by 2021 (2 months after the 2020 election - what a convenient coincidence). (2) Then federal spending would decrease each of the following 3 years. (3) Finally, there would be overall limits to eligibility that would affect the 70 million American children, disabled, elderly and poor who receive benefits. States would not be able to absorb the steep cuts, so there would be draconian cuts to enrollment qualifications, benefits and provider rates.