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What we’re up against: A look at the Senate bill to repeal the ACA

June 29, 2017

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Last week the Senate made public a bill, the so-called Better Care Reconciliation Act of 2017 (BCRA), that would strip healthcare from millions of people and give a one trillion dollar tax break to the wealthy. The bill is even “meaner” than the ACA repeal bill passed by the House, the American Health Care Act (AHCA), and will leave 22 million people without insurance by 2026.

Public outcry against the BRCA forced the GOP to delay today’s scheduled vote on the bill, but the Senate is looking to vote on a revised version – yet to be released – as soon as Senators return from the July 4 recess. As a reconciliation bill, the BCRA is a spending bill that can be expedited through the Senate, requiring merely a simple majority vote and with limited debate time. The bill only needs 50 votes, since Vice President Pence, who would vote in favour of the GOP, would be called to break a tie vote in the Senate. There are currently 52 Republicans in the Senate. If the BCRA passes, the House could then vote on it immediately by utilizing the “martial law” rule, which permits the House to introduce, debate and vote on a bill without requisite time for representatives to read the bill.

The BCRA, in its current form, will:

  • Give states the option to get rid of Essential Health Benefits (EHB), allowing insurers to stop covering or significantly increase the cost of critical care. Out-of-pocket costs for maternity care, mental health care, prescription drugs and substance abuse services could increase by thousands of dollars. The Congressional Budget Office predicts 50% of states would waive EHBs.
  • End protections for people with pre-existing conditions and permit states to impose annual or lifetime limits on health insurance coverage. For the 1.1 million people in the U.S. living with HIV/AIDS, and for people with other chronic conditions or in need of high-cost treatment, these provisions could be life-threatening barriers to continuous treatment.
  • “Defund” Planned Parenthood by blocking federal funds from being used to reimburse care given at Planned Parenthood health centers. In doing so, millions of people, including thousands of LGBTQ people, would lose access to affordable and comprehensive sexual and reproductive health services – including birth control, cancer screenings, HIV testing, STI testing and treatment, and transgender health care.
  • Impose a nationwide ban on private insurance coverage of abortion, undermining the reproductive health options for lesbian, bisexual, intersex and gender non-conforming people, and transgender men, among others in the LGBTQ community who are able to get pregnant.
  • Reduce access to no-cost preventive services, including birth control, STI and HIV testing, and cancer screening.
  • Increase premiums, to the point where the Congressional Budget Office predicts that “few low income people would purchase any plan” at all. It is estimated that, under the BCRA, premiums will be 20 percent higher in 2018, and 10 percent higher in 2019.
  • End Medicaid as we know it: The BCRA will result in 15 million people losing Medicaid over the next 10 years. The bill will also end Medicaid expansion, effectively cutting health coverage for 11 million people. Most importantly, it will gut Medicaid spending by imposing per capita caps. This spending arrangement is predicted to cut Medicaid by $772 billion, with higher cuts than those proposed by the AHCA after 2026. The cuts will force states to choose between dipping into state funds or scaling back on healthcare services for society’s most vulnerable people. The corrosion of Medicaid proposed by the BCRA would impact the lives and wellbeing of 69 million low-income people, disabled people, seniors, and children, including 1.8 million LGBTQ people.
  • Mandate a 60-day ‘waiting period’ to penalize people whose health insurance lapses for over 63 days. This harmful provision differs from the BCRA’s predecessor, the AHCA, which permitted insurance providers to increase coverage costs by 30% after a lapse in coverage.

There is no question that this bill will harm the LGBTQ community, and there is little doubt that the revised version will be just as harmful. Under the Affordable Care Act, we witnessed a 35% reduction in the un-insurance rate for low and middle income LGBTQ people between 2013 and 2017. More LGBTQ people had healthcare coverage than ever. But the BCRA threatens to reverse these gains. Cuts to Medicaid funding and eligibility will devastate access to care for LGBTQ people, who rely on Medicaid to a greater extent than non-LGBTQ people (40% of LGBTQ people compared to 22% of non-LGBTQ people). Undoing the protections provided by the ACA, such as bans on annual and lifetime caps or discriminating against people with pre-existing conditions, will increase LGBTQ health disparities. Furthermore, the bill would undermine HIV prevention efforts, and threaten the lives of thousands of people living with HIV who will no longer be able to access lifesaving treatment. While the precise impact on the insurance rate of the LGBTQ community is not clear, it’s likely the outcome of the BCRA in its current form will be similar to the AHCA prediction: that 1 million LGBTQ people will lose healthcare coverage by 2026.

The BCRA has turned out to be yet another stage in the ongoing fight to protect the ACA and its benefits for the LGBTQ community. Whatever the GOP propose next, we must be resilient and continue to speak out in opposition against any bill that would do anything less than ensure access to comprehensive, affordable, and inclusive care for all.



By Sabrina Rewald, Reproductive Justice Fellow, National LGBTQ Task Force


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