The new Senate Republican bill to repeal and replace the Affordable Care Act could reduce funding, coverage and consumer protections even more sharply than the GOP's previous repeal bill, the Better Care Reconciliation Act.
Here's how:
1. Establishes fixed state block grants that cap federal subsidies for coverage. The BCRA would have continued Obamacare's guaranteed subsidies to qualifying individuals.
2. Ends all federal subsidies in 2026, compared with no subsidy cutoff under the BCRA.
3. Ends Medicaid expansion entirely in 2020. The BCRA would have phased out enhanced funding in 2024 and let states continue expansion using standard federal match funds.
4. States could give insurers unlimited ability to consider pre-existing conditions to set premiums. The BCRA didn't allow that.
5. Eliminates the federal insurance exchange, which states could keep under the BCRA.
6. Offers $25 billion for two-year state reinsurance program. The BCRA offered $182 billion over a decade.
7. No dedicated funding for substance abuse treatment. The BCRA granted $44 billion to states for addiction and recovery care.
8. Doesn't require states to use federal block grant money to help lower-income people buy coverage, unlike the BCRA requirement that subsidies go to lower-income groups.
9. Allows states to waive coverage for preventive services. The BCRA continued ACA's first-dollar coverage for preventive care.
10. Redistributes federal subsidies from Medicaid expansion to non-expansion states—with 20 states receiving about 35% to 60% less than under Obamacare—versus smaller redistributions between the states under the BCRA.
Sources: Kaiser Family Foundation; Center on Budget and Policy Priorities
