ACA & State Reform Update

Posted by Phil Dougherty
June 28, 2017

ACA UPDATE 6/28/2017

The Better Care Reconciliation Act (BCRA), the ACA replacement bill put forth by Senate Republican leadership, is short the necessary votes to pass this month (June), so they will attempt to schedule a vote following the July 4th recess provided they can rally defiant Republicans to support the bill.

The BCRA bill mirrors a House bill in a number of ways, but there are several key differences also. Even if it passes the Senate, it must pass the House first before going to the President for signature. The House could pass it as is, or negotiate a new compromise bill.

Although the specific timing to complete this process is unclear, both Congress and the Administration continue to be focused on the repeal and replacement of the ACA.

For those concerned about immediate changes, the BCRA includes a transition period of several years before some provisions go into effect and others sunset. And not all ACA provisions are impacted by the BCRA bill.

In short, the BCRA would repeal the individual and employer mandate and penalties, end some Medicaid funding, repeal most ACA fees and taxes and maintain some protections for pre-existing conditions. For more details, read this recent Kaiser Foundation update:

Summary of BCRA

California State Reform Measures

Effective July 1, 2017,  bipartisan legislation will go into effect barring “balance billing” from non-participating providers when being treated in In-network facilities. This limits a patient’s cost-sharing responsibility for services rendered from out-of-network providers at an in-network facility, to the amount the patient would have paid to an in-network provider and counts the cost-sharing amount toward the individual’s deductible and out of pocket limit.

A good example of this, and one many of my clients have faced through the years, is when a patient uses an in-network hospital or clinic, and unbeknownst to them, are treated by an out-of-network provider (one who does not contract with the insurer), such as an emergency physician,  second surgeon, radiologist or anesthesiologist. This consumer protection bill is intend to protect health care consumers from these surprise bills. Some welcome legislation.

California Single Payer

The state’s Single Payer initiative will remain “in committee” until further notice. There is still plenty of passion and support for such a solution, but the bill lacks specifics on funding, delivery of care and cost controls. But, it did what many believe it was meant to do: start the discussion and build on the momentum. The goal now among its supporters is to get it on the ballot for November 2018.

More updates to come. Stay tuned.

Phil Dougherty