On June 22, the U.S. Senate released a discussion draft of the Better Care Reconciliation Act (BCRA) to repeal parts of the Affordable Care Act (ACA).

The Better Care Reconciliation Act is the Senate Republicans’ alternative to the American Health Care Act (AHCA) passed in the House in early May. There is not enough support among Senate Republicans to consider the bill this month, so Senate Republican leaders will attempt to schedule a vote on the BCRA following the July 4th recess provided the bill has garnered sufficient Republican backing.

The Better Care Reconciliation Act bill mirrors the House bill in a number of ways but also includes several key differences. The differences are partly the result of special rules surrounding the budget reconciliation process being used in the Senate for this bill, such as requiring that every provision in the bill have direct budgetary impact.

Under reconciliation, Senate Republicans only need to secure a simple majority of 51 votes to pass the bill. There are 52 Republican senators, and the Vice President can vote to break a 50-50 tie, if needed.


Better Care Reconciliation Act Highlights

While it’s anticipated amendments may be made to the Better Care Reconciliation Act before a full Senate vote, here’s how it currently compares to the House’s AHCA:

What’s Similar

·         Repeals individual and employer mandate penalties

·         Ends enhanced funding for Medicaid expansion

·         Expands the individual market age rating band

·         Repeals most ACA fees and taxes, but delays the Cadillac Tax until 2026

·         Incents continuous coverage

What’s Different

·         BCRA adds age- and geography-adjusted components to current income-based subsidies

·         BCRA maintains protections for pre-existing conditions (AHCA allows state waivers to vary premiums by health status)

·         BCRA establishes Association Health Plan rules (called Small Business Health Plans)

If the Better Care Reconciliation Act gets approval, major changes will impact small business health plans. Please contact us so we can analyze your case and work together to make a smooth transition for your employees.