A Breakdown of the Better Care Reconciliation Act

*Content Warning: death, healthcare access, disability, abortion

Just today the GOP senators have released their revised “Better Care Reconciliation Act” (BCRA). Many of us have heard buzz about this bill and have been anxious to see what is actually in it, especially those of us with chronic illnesses and disabilities. Since it is so recently released, it is difficult to find a breakdown of what is in it, but I found one at US Senate Committee on the Budget and I’m going to share some of my findings with you guys.

First, let me say that after spending a couple hours reading through all of that legalize, I feel like my eyeballs are going to start bleeding. It doesn’t help that the more I read, the more upset I would get, causing my heart rate to gradually increase the further into it all I went. Second, do not take what is seen on the home page of the Senate Committee site as a thorough evaluation of the bill. My suspicion is that they put the breakdown there that they did, carefully worded to gloss over incredibly harmful points, in order to ease the anxiety of many and make this bill seem much less harmful than it actually is. And it is harmful. People absolutely will die.

But you don’t have to take my word for it, you can read it yourself like I did (which I highly recommend) here or you can read the full senate breakdown/summary of each individual section here and here. That’s how I learned what I’ve learned about the bill and all quotes I share below are straight from either the bill itself or the bill summary. I won’t go through each and every section here, mainly because I don’t have the strength or energy for it, but I am going to try to highlight some of the most important sections that I think people need to be aware of.

Even still, this will be a long post, so strap in for the ride! Feel free to skip to the parts that apply most to you, but, if you can, read through it all to get a better understanding of what’s in the bill. And yes, a lot of my opinion and personal experiences will be littered in as well, take them as you will.

Here we go:

Tax Breaks and Money Shelters: AKA Benefits for the Wealthy

In the first few pages of the bill, there are 15 sections that directly refer to taxes and Health Savings Accounts. This new bill lifts many of the Affordable Care Act (ACA) tax laws. Including taxes that companies, healthcare providers, and insurers pay for prescriptions, medical devices, and chronic care. This also includes the repeal of the tanning tax, something I personally found a little hilarious considering our presidents love of artificial tanning. “Section 117 would repeal the tax on indoor tanning services (IRC Chapter 49), effective for services performed after September 30, 2017.”

These tax breaks don’t benefit the lay people, they really only benefit the people running these billion dollar corporations. You know, the ones who really need it.

They also specify a lot of amendments to Health Savings Accounts (HSA) and Flexible Savings Accounts (FSA). They have lifted any restrictions on contributions to FSAs as well as limitations on HSAs. They also make it to were insurance can be purchased through funds from the HSAs and that couples can combine their funds into one HSA. Here’s the problem with that though, most people who can actually afford to put money aside into a savings account aren’t the people who need help paying their medical bills. HSAs, more often than not, turn into tax shelters for the rich, as they can put money in there tax free. If this bill passes, they can put as much money in there as they’d like, hiding it away from the IRS under the guise that it will be used for their healthcare.



The individual mandate is probably the most controversial part of the ACA. A lot of people don’t like the idea of being forced to buy insurance. The purpose of the mandate is to balance out the number of healthy people on insurance vs the number of sick people. The premiums covered by the healthier people help to cover the higher medical costs of the chronically ill and elderly. If only people who actually need insurance have it, then the system breaks down. At least, our for profit privatized system. That individual mandate has been essentially removed. Completely removing the mandate is slightly more complicated, therefore they propose a change in the cost of the fee, lowering it to $0. “Section 104 would modify the annual penalty associated with IRC Section 5000A, eliminating it by reducing the percentage of income to 0% and the flat dollar amount to $0, retroactively beginning in calendar year (CY) 2016.”

But, don’t get too excited about that. Because, as mentioned before, the system relies on healthy people buying insurance without using it much, and because insurance companies want to cover as few sick people as possible (after all, they are in the business of making money, not catering to the ill) so they don’t want people jumping onto insurance when they get sick only to hop right back off once they’re better, some kind of incentive has to be put in place to get people to buy insurance. So, if you go 63 days without qualifying insurance (we’ll get to the qualifying part later) within one year then you get put on a 6 month wait for insurance. That’s right, 6 whole months: “would be required to impose a 6 month waiting period on individuals who had a gap in creditable coverage.”

You might be thinking that that doesn’t sound that bad for a young healthy kid who doesn’t really need insurance. But what if you lose your job, therefore insurance, and can’t afford any other plans? What if you are forced to lose care by no fault of your own? You will then have to wait 6 whole months before being able to get coverage again. Even for a healthy person, a whole lot of things can happen and go wrong in 6 months.

The BCRA also removes the Employer Mandate, which required employers to provide insurance benefits to their employees: “Section 105 would modify the tax penalty associated with IRC Section 4980H, eliminating it by reducing the penalty to $0 retroactively beginning in CY2016.” Therefore, less people will have access to healthcare through their job, forcing them onto the marketplace….


Marketplace Insurance

Ok, this is a tricky area bc there are a lot of different parts that are affected in different ways. I’m going to try to put it in some sort of logical pattern. 1) The income bracket for subsidies would be changed. It currently goes up to 400% of the Federal Poverty Line, but they want to change that to 350%. They also want to change the amount the subsidies cover. Currently, the ACA bases subsidies on 70% of the cost of silver tier plans (middle of the road). These changes would base the subsidies on 58% of the median plan available for the area. Since catastrophic plans are being added into the mix (cheaper plans that cover very little), the median price will be dragged down lower. These subsidies can also be used to cover the premiums for catastrophic plans.

I mean, that’s if your state wants to offer cost-sharing subsidies, as it is listed as one of the sections that states can choose to waive: “however, in other sections of the legislation, the draft bill would alter three of the provisions that can be waived under a 1332 waiver: the individual mandate (Section 104), the employer mandate (Section 105), and the cost-sharing subsidies (Section 208).”

Changes would be made to eligibility for “alien” residents (migrants) as well as people who have any kind of health plan available through their work. So, if your work offers only a super crappy plan, you can either take that or not get any subsidies. This is going to severely limit people’s options when it comes to care and it’s affordability. For instance, when I was working full time, my job offered insurance plans but they were so expensive that I couldn’t afford them. The ACA allowed to me get subsidies that helped me with the costs of my premiums and made it to where I could get a good plan at an affordable price.

If this passes, we will once again be returning to an era where people are stuck in horrible jobs simply because they can’t afford to lose their coverage.


Pre-existing Conditions

I didn’t see the words “pre-existing condition” come up in the entire 27 page document. That would seem like a good thing, as that would make it seem that they are keeping the current section requiring that coverage not be denied due to pre-existing conditions. However, the bill allows for states to decide what kind of benefits are offered, or what services will be covered, with very little oversight by the Federal Govt as long as the plans don’t violate the qualified plans or add to the deficit in anyway. Basically saying that states are encouraged to cut benefits as much as possible, adding benefits to help their residents will be overruled: “Instead, the draft bill would require the Secretary to grant a state’s waiver request unless the Secretary determines that the state’s application has required elements that are missing, or the state’s plan would increase the federal deficit. The determination about whether the state’s plan increases the federal deficit would not take into account the new funding that would be made available under Section 207, as described in the following two paragraphs.”

In short, a state has to offer a marketplace and can’t deny someone care because they have a pre-existing condition. But, they can decide that they won’t cover chemotherapy for anyone, making it to where cancer patients have plans that won’t really help them much.



If the sections above haven’t been enough to frustrate you with this bill, this one should do the trick. Well, I suppose that depends on if you think that children, the disabled, the elderly, and other vulnerable groups deserve care.

There are multiple parts of the proposed changes to Medicaid that are absolutely atrocious, but, to me, the absolute worst is the “State Option for Work Requirements.” This new section will allow states to require all non-disabled, non-elderly, and non-pregnant (through pregnancy and up to only 60 days after birth) people to meet work requirements in order to receive Medicaid. If any one section of this bill could show “the GOP does not think that healthcare is a right” it’s this one right here: “Section 130(a) would modify SSA Section 1902 by adding a new subsection (oo) to permit states, effective October 1, 2017, to require nondisabled, non-elderly, nonpregnant individuals to satisfy a work requirement as a condition for receipt of Medicaid medical assistance.”

If you don’t already understand why this is a horrible idea, let me break down some of the many reasons why. 1) Just because the state has not put you on disability, does not mean you aren’t disabled. I am not currently on disability, even though I applied over a year ago. As mentioned in a previous post, the average wait time in the US to get on disability is 2-3 years and with only a 48% approval rate. That means that there are many people who are physically or mentally unable to work but who have not yet been deemed disabled by the government. For states that choose this option, those people will most likely have to lose their healthcare, something that can mean death to many of them.

2) It’s not always that easy to just up and get a job. As Charlie Kelly exclaims in It’s Always Sunny in Philadelphia, “Just get a job? Why don’t I strap on my job helmet and squeeze down into a job cannon and fire off into job land, where jobs grow on jobbies?!?” The fact is, Medicaid is needed more in places where jobs are less available. Requiring that people get a job before they can get Medicaid is counter-intuitive. Many people on Medicaid, who aren’t disabled, elderly, or pregnant, are on it precisely because they haven’t been able to get a job but still need/deserve care. It’s another provision that will force people to stay in places and jobs with horrible conditions because they can’t afford to lose their healthcare options.

Ok, I lied. I’m not sure if the “Work for Benefits” section is more horrible or the benefits caps. The proposed bill not only places yearly per capita (per person) benefit caps, but it also institutes lifetime benefit caps. So, if a child is born with a chronic illness that renders them disabled, requiring them to receive multiple expensive treatments and/or tests a year, then they could easily hit a lifetime cap before they’re even 18. Or, let’s say someone on Medicaid gets cancer, requiring extremely expensive chemotherapy treatments, tests, possibly even surgeries. If they hit their yearly limit say 6 months into treatments, then they will have to wait another 6 months to receive any kind of medical assistance…that is, if they live that long.

States are also getting less money to fund Medicaid, and will receive bonuses for saving money while being punished if they go over. It also requires citizens to reapply, at minimum, every 6 months, although states can choose to have them do so more often in they want to. The bill makes it incredibly clear that they want as few people as possible to be covered and that states better join along or risk losing all of their healthcare federal funding.


Planned Parenthood and Abortions

As if healthcare wasn’t enough of a hot topic, let’s talk about Planned Parenthood and abortion coverage for a quick second. Feel free to skip this section if you are vehemently opposed to PP or abortions, I can’t nor would I, force anyone to read it!

This healthcare bill ends federal funding to Planned Parenthood. A lot of people think of Planned Parenthood as an abortion clinic, when, in fact, abortions are only a small percentage of what they do. For years, they have provided free cancer screenings, access to birth control, annual exams, and family planning education. The number one way to prevent or decrease abortions is to increase access to birth control as well as education for sex health and family planning. Places that preach abstinence only sex education and limit access to birth control have the highest abortion rates, as well as the highest teen pregnancy rates.

Often, when people think of Planned Parenthood they think of teens going to secretly get birth control or get abortions. They don’t think about the married, mother of 4, who can’t afford another baby but also can’t afford the high cost of birth control. Should she not be allowed to be intimate with her husband because birth control has been made so unaffordable? Birth control is also used to treat and/or manage many different health problems in women. Denying them access to affordable birth control is the same as denying diabetics access to insulin.

The bill is also very clear on it’s stance on abortions in general. Citizens cannot use federal subsidies to purchase insurance plans that cover abortions (except those that show threat to the mother’s health and/or in cases of rape or incest). Funds from HSAs cannot be used to pay for premiums of insurance plans that cover abortions. States can lose federal funding if they offer any plans on their marketplace that cover abortions. You get the idea. They are basically working to repeal as much of Roe V Wade as they can through financial availability.

I get it. A lot of you are probably screaming “yes!” at your screen right now. But, I want you to try to consider a couple of things. Whether you agree with abortion or not, it has been deemed legal by the Supreme Court. It sets a pretty scary precedent for our government to be able to essentially overturn a Supreme Court ruling by denying states and citizens access to federal funds. To me, it sounds a bit like coercion or blackmail. People would be in an uproar if, for instance, the government decided that, while you still technically have the right to own a gun, you cannot get a driver’s license as long as you own one. Ok, that’s not the best example, but cut me some slack. This is a really long article so my spoons are running out!

The other thing to consider is that, since states would have the right to choose what things insurance covers, they can (and I’m positive many will) refuse to cover the cost of birth control. Not only is that a gross injustice and overstepping the divide between religion and state, but when combined with minimal (if any) access to abortions, no centers to get affordable access to birth control, limited access to healthcare in general, as well as increased restrictions on Medicaid, we will see a huge surge of women dying from back alley abortions out of desperation, as well as children in foster care (a place that is already overrun with children it can’t place or take adequate care of).


My thoughts…

If I didn’t already make this abundantly clear, I think this bill is a travesty. It is essentially a giant tax cut for the wealthy and a giant middle finger to the disabled, poor, and even the working class. It gives more power to insurance companies and healthcare providers, who are already bilking us for every dollar we’ve got, and encourages states to offer as little coverage as possible for it’s citizens.

This bill all but states that the GOP party values wealthy people over the rights of the US citizens. Millions will suffer, including many middle class working citizens. Many, many people will die. I could very easily be one of them. This bill feels like state funded genocide of the disabled, ill, elderly, and poor, as those are the groups that will be affected the most. This bill is a threat to my very existence.

You don’t have to take my word for it, feel free to read the bill and/or summary yourself. I always encourage that. I am not a lawyer or law maker, so it is possible that I have missed something or misinterpreted something. But, please, if you care about the lives of your fellow citizens at all, or if your own life is being put at risk by this bill, contact your representatives and let them know that this bill absolutely must not pass. Many lives depend on it.


If you made it this far, congratulations! Thank you for sticking with me! Do you have a comment about the proposed bill? Or is there something I missed that you want to talk about? Leave me a comment below and let me know!


© 2017 spooniewarrior.com


I am a mother, partner, teacher, daughter, writer, and blogger. I'm working on turning my private hobby into a public one, whether the public asked for it or not. I have a BA in theatre and a Master's in Education (with a Montessori integration), making me a highly overqualified internet ranter.

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