Senate Majority Leader Mitch McConnell unveiled a revised version of the Republican health care bill Thursday that GOP leadership hopes will help secure the 50 votes they need to repeal and replace the Affordable Care Act.
The revised Better Care Reconciliation Act — which McConnell hopes the Senate will vote on next week — will have to somehow satisfy party moderates who feel the original BCRA severed too many of the ACA’s protections as well as conservatives who feel it was too similar to Obamacare.
Here are the four major ways the new BCRA differentiates itself from the old.
Health Savings Accounts
Under the new BCRA, individuals would be able to use their health savings accounts to pay their insurance premiums. Republicans also say that HSAs could be part of “state-based reforms” to drive down premiums and defray out-of-pocket costs.
Critics — including Center for American Progress fiscal policy director Harry Stein — say this represents a “new tax cut for the rich,” as “very few moderate-income households use HSAs.”
“Make no mistake,” Stein tweeted. “#Trumpcare is still about cutting taxes for rich people.”
President Donald Trump has called opioid abuse a “crippling problem” for the United States and in March launched a committee to address the issue. The commission, helmed by New Jersey Gov. Chris Christie, just missed its second deadline to outline a plan to deal with the crisis.
Sen. Ted Cruz (R-Texas) proposed an amendment to the BCRA that would allow insurance companies to sell plans that don’t conform to ACA rules — such as those requiring coverage for pre-existing conditions and essential health benefits like hospital visits, prescription drugs and maternity care — as long as they also offer plans that do.
Critics said the plan would result in a split insurance market that saddles older, sicker Americans with higher premiums.
A version of the so-called “Cruz amendment” has been included in the revised BCRA, but McConnell and other top Senate Republicans have indicated they may not include it in the final plan if the Congressional Budget Office score they hope to receive early next week shows the amendment hurts the bill’s chances at passing.
Sen. Mike Lee (R-Utah), who has also backed the amendment, tweeted before the bill was unveiled that the version included is not the amendment he had originally supported.
Tax cuts for the wealthy
The original BCRA’s tax cuts, which former President Barack Obama and other critics said benefitted the “richest people in America,” have been removed in the revised bill.
The new BCRA leaves the taxes imposed on the wealthy by Obama’s plan in place, but would still target the ACA’s Medicaid expansion and dramatically cut its funding in the long term — an issue that has drawn criticism from moderate Republicans.
Correction: July 13, 2017
A previous version of this story misidentified the amount of money the Better Care Reconciliation Act would allocate to addressing the opioid crisis. It would devote $45 billion.