The Senate Health Care Bill and Cancer

BCRA would have major impact on cancer community

The Senate’s bill to repeal and replace the Affordable Care Act (ACA) contains several policy changes that would have a significant impact on the cancer community. A vote on the bill was postponed this week, yet it is expected to be revised quickly.

Senate Republicans drafted the Better Care Reconciliation Act (BCRA) in response to the American Health Care Act (AHCA), which was passed by the House of Representatives on May 4, 2017.  

The Senate delayed the BCRA vote after losing support from key Republicans, including Wisconsin Sen. Ron Johnson. On Monday, the Congressional Budget Office determined the bill would increase the number of uninsured Americans by 22 million by 2026. The CBO also found that while the bill would decrease premiums, it would increase out-of-pocket costs for a majority of Americans purchasing insurance on the individual market.

What the BCRA does

Many policy changes in the current draft of the BCRA that affect the cancer community were also a part of the AHCA, while some are new.

Specifically, the BCRA would:

  • Repeal the Prevention and Public Health Fund, which provides funding to the Centers for Disease Control and Prevention (CDC) and other public health agencies for important cancer control priorities such as immunization and tobacco awareness programs.
  • Prohibit Medicaid patients from receiving cancer screenings and other health care services at Planned Parenthood for one year.
  • Cap funding for the Medicaid program, which provides access to cancer prevention, screening, and treatment services to many people with low incomes, through either a per-capita amount or a block grant.
  • Eliminate cost-sharing subsidies that reduce deductibles and out-of-pocket costs for Marketplace enrollees with low incomes.
  • Increase the amount insurers can charge older adults relative to younger adults from 3:1 to 5:1.
  • Repeal most of the ACA’s taxes, including the tanning tax.
  • Loosen restrictions on ACA-created waivers (Section 1332) that allow states to opt out of certain consumer protections, like limits on out-of-pocket costs and essential health benefits rules that provide comprehensive coverage free from annual or lifetime limits. Note: The current draft of the BCRA does not allow states to waive community rating, which requires that people with pre-existing conditions are charged the same rates as healthy individuals when buying health insurance.
  • Institute a mandatory six-month waiting period for people who have a gap in coverage of more than 63 days before their purchased coverage would begin.
  • Keep an ACA-like structure to premium tax credits. However, the BCRA would make a few significant changes to these tax credits that would affect who is eligible for reduced premiums, and how much the tax credits would be worth:
    • Reducing the upper income-limit for tax credit eligibility from 400% of the federal poverty level (FPL) to 350% FPL.
    • Expanding tax credit eligibility to individuals between 0-100% of FPL (Note: In Wisconsin, people in this income range are currently eligible for BadgerCare).
    • Decreasing tax credit amounts for older adults, and increasing them for younger people.
    • Decreasing the value of tax credits by basing them on plans with a lower actuarial value, meaning with higher deductibles and out-of-pocket costs.

The bottom line for cancer control

Having health insurance increases access to care and improves overall health. Cancer patients and survivors need consistent, reliable access to health insurance that offers comprehensive benefits and protects against the high costs of cancer care. Additionally, prevention efforts such as those made possible by the Prevention and Public Health Fund are key to reducing the cancer burden in our state and nation.

Supporting cancer prevention and increasing access to quality cancer care through affordable public and private health insurance are priorities of both the WI Comprehensive Cancer Control Plan 2015-2020 and the WI Cancer Council Policy Agenda. These priorities offer important considerations for the cancer community when examining the implications the BCRA or any future health care legislation.

To learn how current health care legislation compares to the ACA, visit this comparison table, which is regularly updated as bills are proposed and changed. Also, find your county on this interactive map to learn how premium amounts and tax credits would change for different groups of people in your area.

Note: The Senate is expected to release a revised version of BCRA as early as Friday, July 30, and may vote on its passage sometime after the weeklong July 4th recess.