The Senate Healthcare Bill
Here’s the Senate’s Big Secret
Senate Republicans revealed their secret healthcare plan on Thursday — The Better Care Reconciliation Act. Here are some things you should know about it and its impact on all of us.
Adults Under 65
- For adults under 65, those aged from 59–64 will pay five times more than the youngest of us.
- Insurance subsidies will end at incomes of 350% of poverty level. Adults 59–64 will pay up to 16.2% of their income; with a median household income nationwide of $63,151 for people from 55–64 that equals about $10,230 or $853 per month. Medicaid cuts begin in 2021 (one year later than the House bill).
Low Income Residents of Nursing Homes and Skilled Nursing Facilities
- Skilled nursing care would be covered by Medicare for up to 100 days. Skilled nursing care is medical care that is provided by trained individuals such as registered nurses, and speech, occupational, and physical therapists. Some examples of services include wound care, IV therapy, injections, physical therapy, monitoring of vital signs, and medical equipment. It is important to know that while many people need this care for a relatively short duration due to illness or injury, many other people may need this care on a long-term basis due to chronic illness. Medicaid coverage for long-term care could be cut due to proposed declining levels of federal support for states.
- Insurance companies will be required to cover all applicants regardless of health status, but as with the House Bill, states could ask permission to reduce what is covered under essential health benefits — these are:
- Outpatient care
- Emergency services
- Inpatient care
- Maternity and newborn care
- Mental health and substance abuse services
- Prescription drugs
- Services and devices for recovery from injury, disability, or chronic condition including, physical and occupational therapy, speech therapy, and more.
- Lab tests
- Preventive services such as counseling, screenings, and vaccines
- Pediatric services, including dental and vision care for kids
Should states decide to reduce this coverage, insurers will be given discretion over what they offer in plans and can base cost to consumers on how much coverage is offered.
- No federal reimbursement for any services that Planned Parenthood provides. Federal reimbursement for abortion services is already blocked by the Hyde Amendment.
- Here’s a breakdown of the services Planned Parenthood offers (information is from 2014):
- 3% abortions
- 34% contraception
- 1.1 million pregnancy tests
- prenatal care
- 42% STD screening and treatment
- 62% of their health centers offer same-day appointments, 78% offer extended evening and weekend hours.
- Planned Parenthood health centers serve 36% of all people who need publicly funded family planning centers — 20.2 million women are estimated to be in need of the services provided by Planned Parenthood. 26% of Planned Parenthood patients reported in 2016 that it was the only place they could go for the services they needed.
People with Disabilities on Medicaid
According the Kaiser Family Foundation, in 2015 more than 10 million children and adults qualify for Medicaid due to disability. This includes people with physical impairments and conditions like cerebral palsy, epilepsy, people with HIV/AIDS, severe depression, schizophrenia, intellectual and developmental disabilities and many more. The majority of these people need Medicaid because of the correlation between poverty and disability. Most people with disabilities do not have access to commercial insurance because it does not cover the scope of the services that many people with disabilities need.
- Medicaid services will be cut — through declines in federal funding to states. The cuts in the Senate bill are higher than those in the House bill.
People on Medicaid Needing Mental Health Services
- Medicaid will no longer be required to cover mental health services after 2015.
Working Poor on Medicaid
According to Congressional Budget Office estimates, in 2015 Medicaid provided health coverage for 97 million low-income Americans — 33 million children, 27 million adults, and 6 million seniors in addition to the 10 million people with disabilities who are covered.
- The federal expansion for Medicaid is phased out between 2021 and 2023.
- Eight states would have a clause that mandates the end of Medicaid expansion immediately if the federal matching rate declines below the ACA rates. This will affect Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico, and Washington. There will be additional reductions beginning in 2025.
Insurance for the Wealthy
Much like the House bill, which cuts ACA taxes on corporations and includes tax cuts for the wealthy of $592 billion, the Senate bill also repeals taxes and provides tax cuts. For an interesting take on the likelihood of the bill’s passage, see Nate Silver’s post today:
For information from people who support the bill:
For information from people who oppose the bill:
For a summary of the bill as it compares to ACA and the House bill:
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