4 things to know about the status of the Better Care Reconciliation Act

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With so much happening in regards to health reform efforts, it’s vital that both employers and advisers pay attention to the latest changes in the Republicans’ healthcare bill.

During a webinar last week, sponsored by the Health Agents for America, a Baton Rouge, La.-based adviser trade group, Matt Gallivan, a health policy adviser for Sen. Bill Cassidy (R-La.), shared an update on four key elements of the reform process:

1) When the new bill will drop: Gallivan said the talk on Capitol Hill is that the new bill will be available to members and the public late this week, with the potential to move forward on it the following week.

Ronnell Nolan, CEO of Health Agents for America, adds that if that vote is unable to take place, there is discussion on Capitol Hill of going down other avenues, such as piecemeal legislation. Such legislation, Nolan has heard, would focus on stabilizing the insurance market for individuals who may have no options in 2018 on the public exchanges, she said in a follow-up interview.

2) If repealing the bill now and replacing later would work: In a recent tweet, President Donald Trump floated the idea of repealing the Affordable Care Act now and replacing it at a later point. A few others, including Sens. Rand Paul of Kentucky and Ben Sasse of Nebraska, have partially supported this idea. However, Gallivan says it is unlikely to happen, “because you would be voting for a bill that the Congressional Budget Office would score as increasing the uninsured rate by 30 million and premiums would go up 50%.”

“There would be a lot of people who would sit there and [express] concern about the instability that would create … with no guarantee to pass a replacement,” he says. “The market would go into such a tailspin that it would be hard to recover from.”

3) Why navigators weren’t included in this legislation: Long a sore point for advisers who felt navigators were taking their place in the ACA’s health insurance markets, Nolan says there is no mention of the ACA’s navigators in this bill because GOP leaders are intending to pass it through reconciliation, which only requires a simple majority and must pertain to the federal budget. The “budgetary aspect … must be a driving element of it,” Gallivan said.

Nolan believes regulatory action from the Centers for Medicare and Medicaid Services may follow to alter or eliminate navigators after a bill is signed by Trump.

4) How the Congressional Budget Office scores: One main reason that McConnell’s first version of the bill was put on hold was because of a CBO score indicating the new bill would lead to a large number of uninsured Americans. Nolan explains that CBO is not always accurate, as happened with the ACA. Therefore, webinar attendees wondered why CBO should play such a large part in the legislative process.

Gallivan explained that CBO scoring is not treated as the “be all, end all.” But, “both sides cherry-pick when the numbers are convenient,” he added. His boss, Cassidy, is looking to an independent arbitrator to confirm or verify the numbers.

“[CBO] is indeed a point and should be a treated as a data point,” Gallivan said. “Sen. Cassidy thinks we should have benefit plan design managers and health agents involved in this to show where the marketplace is and where it is going.”

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