Both BCRA and AHCA would allow states to receive Medicaid funds in the form of a block grant- this would enable states to construct their programs and funding to fit the needs and priorities of their residents, rather than be subject to inflexible federal rules that may make no sense across different contexts.

Sounds good, right? Not so fast. On the Health Affairs blog, Prof. Marianne Bitler and I argue that the history of welfare reform shows it may not be that easy.

How many acronyms were up there? (A few) Senate Republicans released their draft response to the House American Health Care Act, the Better Care Reconciliation Act.  There is much more detail in BCRA, and yet the upshot seems to be that BCRA ups the ante from the AHCA on disparities, again favoring the younger, healthier and wealthier vs. the poorer, sicker, and older.

Others have written excellent summaries of the BCRA overall, as well as specific review of changes to Medicaid not related to caps,  So I won’t waste your time or mine.

A couple points-

1. Immigrants: There’s a small distinction which appears to restrict premium tax credits from a subset of immigrants, all of whom are Lawfully Present (allowed to stay in US)  but now limited to Qualified Aliens vs. Non-Qualified Aliens.  As a non-expert, Non-qualified is utterly confusing to me and all I have figured out so far is that those under DACA are Non-Qualified and therefore would not be eligible for tax credits to purchase health insurance.
2. Elimination of the ACA Public Health and Prevention Fund: once again signaling how the U.S. simply does not prioritize public health.
3. Tax cuts for the wealthy: Income inequality goes up–> Health disparities go up.

CBO stands for Congressional Budget Office. The CBO is a non-partisan office that serves Congress by performing independent analyses of proposed legislation. In other words, when Congress is considering a bill to say, change health care, the CBO analyzes the bill and tries to estimate how much the bill will cost, who is affected, and how.

What does the CBO say about the latest version of the American Health Care Act?
Depends on who you are reading/listening to.
23 million more uninsured!Reduces deficit by $119 billion! Premiums are lower. No, premiums are higher!

From a disparities perspective, the CBO score reflects what was already present in the prior analysis of the AHCA:

• Those who with lower incomes, and are older and sicker, will lose coverage.
  • All the maneuvering before the bill was passed didn’t change the proposed cuts of $843 billion from Medicaid –> 14 million will lose Medicaid coverage
  • CBO estimates that for low-income adults: 21-year-olds see a small drop in premiums, from $1700 to $1250. However, it’s not as if young adults are going to paying less for the same thing. They will pay less for less.
  • 64-year-olds, on the other hand, see an increase anywhere from $13,600 to $16,100. This is for someone making $26,500 a year, i.e. more than half their income would go to health insurance, with possibly fewer benefits.
• Final score: deficit down, disparities up.