Senate Releases Better Care Reconciliation Act (BCRA)

On June 22, 2017 Senate Republicans issued their own proposed legislation to repeal and replace the Affordable Care Act (ACA), called the Better Care Reconciliation Act (BCRA). The bill is comparable to the American Health Care Act (ACHA), including by enhancing HSAs, repealing the employer and individual mandates, and preserving some ACA protections.

Enhancing Health Savings Accounts (HSAs)

The BCRA would:

  • Increase the maximum HSA contribution limit – The contribution limit would rise from $3,400 for self-coverage to $6,550 and from $6,750 family coverage to $13,100.
  • Allow both spouses to make catch-up contributions to the same HSA – The BCRA would allow both spouses of a married couple to make catch-up contributions to one HSA beginning in 2018, if both spouses are eligible for catch-up contributions and either has family coverage.
  • Address expenses incurred prior to establishment of an HSA – If an HSA is established within 60 days after an individual’s high deductible health plan (HDHP) coverage begins, the HSA funds would be able to be used to pay for expenses incurred starting on the date the HDHP coverage began.

The key differences between the AHCA and BCRA relate to the Medicaid program.

Modernize Medicaid

  • BCRA would provide enhanced federal payments to states that already expanded their Medicaid programs, and then transition Medicaid’s financing to a “per capita allotment” model starting in 2021, where per-enrollee limits would be imposed on federal payments to states
  • Unlike the AHCA, the BCRA would guarantee coverage for children with medically complex disabilities and ease restrictions on coverage of treatment for mental diseases in psychiatric hospitals.

The Senate Republicans would like to vote on the BCRA before July 4. For a more detailed and in depth look at the ACA replacement bill, download the complete ACA compliance bulletin here .