Yesterday, U.S. Senate Republicans revealed details of the Better Care Reconciliation Act (BCRA), their proposed healthcare bill to repeal and replace the Affordable Care Act (ACA). Like the bill narrowly passed by the House in May, the Senate bill would make significant cuts to Medicaid, a public health insurance program for low-income children, pregnant women, parents of dependent children, seniors, and people with disabilities. The ACA gave states the option to expand Medicaid eligibility to low-income adults who do not have other qualifying factors such as a disability or primary care responsibility for a child. This provision greatly benefitted low-income LGBT adults as well as people living with HIV (PLHIV).
“The rates of uninsurance among LGBT people and people living with HIV dropped dramatically after the Affordable Care Act’s Medicaid expansion was implemented,” said Sean Cahill, Director of Health Policy Research at The Fenway Institute of Fenway Health. “While this bill would delay the dismantling of the Medicaid expansion, we don’t see anything that would preserve those gains.”
The Senate bill would end the expansion of Medicaid permitted under the ACA and make additional cuts to the program. The BCRA would offer states a lump sum of funding for use in covering health insurance costs based on the state’s eligible population. This per capita funding would be tied to the growth rate of standard inflation, which is a slower rate of growth than medical inflation. This would result in a deeper cut to funding for Medicaid than in the House version of the bill. These cuts to Medicaid funding would inevitably lead states to cut enrollment and benefits from their Medicaid plans.
The Senate bill would reduce the number of individuals eligible for federal insurance subsidies to purchase private health insurance plans, and prohibit federal reimbursement for services performed at Planned Parenthood health clinics for at least a year. Additionally, the Senate bill would allow states to opt out of many of the ACA’s health insurance requirements, including rules for what constitutes a qualified health plan and what health benefits must be covered. The ACA currently requires coverage of essential health benefits, including HIV/STI screening and behavioral health care.
“These benefits are especially important for LGBT people, people who are living with HIV, and other vulnerable populations that are disproportionately burdened by health disparities and experience barriers to accessing healthcare,” Cahill added. “This bill, if passed, would inevitably result in fewer people being insured compared to the Affordable Care Act, and reduce the health benefits of those who are able to retain their insurance coverage. Both of these changes would disproportionately harm LGBT people, PLWH, and people with other chronic diseases.”
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