Medicaid in the Crosshairs: Senate Releases Proposal to Repeal & Replace the ACA

This morning the U.S. Senate released draft healthcare legislation entitled the “Better Care Reconciliation Act of 2017”.  Note that it has a different name than the House version that passed a few weeks ago (American Health Care Act).  In many respects, the two bills are very similar.

They're calling this a "discussion draft", implying that it's possible that the language of the bill could morph before it hits the Senate floor next week.

The non-partisan Congressional Budget Office is still working on an evaluation of the Senate version.  That evaluation will provide a better picture of the practical impacts that the bill would have if enacted, however, here's what we know from the initial reading of the discussion draft: 

  • Like the House version, BCRA would give states either a per capita cap for federal Medicaid contributions or a block grant of funds beginning in 2020. It appears that, unlike the House version, federal funds for kids the elderly and people with disabilities could not be "block granted" (an improvement).  On the down side, the inflation rate used to calculate future per capita contributions would be even lower than the inflation rate in AHCA which will result in less Medicaid spending in 2025.

  • Rolls back the Medicaid expansion (to 138% of poverty), but more slowly than the House version. Would creates some kind of state innovation fund for states that didn't expand Medicaid.

  • Eliminates the individual mandate for everybody to have health insurance.

  • Eliminates the requirement that larger employers provide health insurance to their employees.

  • Insurance companies would still not be allowed to increase premiums or deny coverage based on preexisting conditions.

  • States would be allowed to change what qualifies as an essential health benefit for Marketplace plans.

  • Completely eliminates the Prevention and Public Health Fund (PPHF) in FY18, which is used by every state to support vital public health programs that promote health, prevent disease, and allow for rapid response to emerging public health threats.

The Century Foundation has a good comparison of the House and Senate Versions as well as the current law under the Affordable Care Act on their website here:   ;


We're encouraging AzPHA members to send messages to our Senators urging them to focus on supporting a Senate bill that: 1)  protects futue funding for Medicaid; 2) allows folks with pre-existing conditions to be able to continue to have access to affordable health insurance; and 3) protects the Prevention and Public Health Fund.

Senator John McCain

Washington, DC Office:       202.224.2235

Phoenix Office:                    602.952.2410

Senator Jeff Flake

Washington, DC Office:       202.224.4521

Phoenix Office:                    602.840.1891