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Takeaways from Senate’s “Better Care Reconciliation Act”

Takeaways from Senate’s “Better Care Reconciliation Act”

The much ballyhooed Senate Republican health reform overhaul – the “Better Care Reconciliation Act of 2017” – was released today after weeks of intrigue.

The politics of the legislation are unclear, as GOP leaders have virtually no margin for error in a vote that Majority Leader Mitch McConnell intends to push by the end of next week. They may lose only two votes, assuming Vice President Mike Pence will cast the deciding party-line vote.

The Council is extremely pleased to note that the legislation leaves the employer/employee “exclusion” from taxation on group health benefits untouched.

Taxing employee premiums is a major threat during this process as Congress looks to increase revenue for the measure.

We’re also gratified that the “Cadillac Tax” on high cost health plans would continue to be delayed until 2025.

The House-passed American Health Care Act also included a provision that would delay implementation of the tax until 2025 (from the current law which would implement the tax in 2018).  We will continue our efforts to see a complete elimination of the Cadillac Tax.

Top Level PoliticsConsidering the fact that preservation of the employer-provided group health insurance marketplace has been the top priority of The Council’s for years, we are relieved and grateful at these provisions.The fight going forward is going to be over the reoriented subsidies and Medicaid. There is nothing explicit that allows states to waive out of anything new but the general waiver requirements process has been expanded.The significant problems in the individual and exchange marketplaces, and corresponding cuts to the federal safety net of Medicaid, will have consequences for years to come on the entirety of the health care ecosystem – as evidenced by the growing political movements on the left in support of single-payer health coverage.As we continue to digest the political and practical consequences of this legislation, we will be issuing a summaryof key provisions of the legislation as prepared by our legal team at Steptoe & Johnson, later this afternoon.


  • Zeros out individual and employer mandates
  • Modifies but keeps the individual credits; ties credits to age bands (5) and reduces eligibility to families under 350% of poverty line (from 400 before), but if you have access to employer coverage, you are ineligible with no requirement that the employer coverage be “affordable”
  • Eliminates small business tax credit regime for health care insurance after 12/31/19 AND between now and then small business health plans are ineligible for the credit if they cover abortion services
  • Generally repeals all of the taxes in effect after 12/31/17. The Medicare excise tax does not go away until after 12/31/2022 but net investment tax goes away effective 12/31/16.
  • ACA HSA and FSA limits repealed so back to the $5,000 caps
  • Other HSA reforms are same as in AHCA – increases the maximum contribution (to be equal to the plans out of pocket limits); allows spousal and catch-up contributions; and allows expenses incurred within 60 days of establishing an HSA to be covered. Does not deal with on-site medical clinic or telemedicine issue.
  • Eliminates federal MLR rebate regime after next year but requires each State to establish its own MLR regime with rebates
  • Most Significant Development: allows for the establishment of association health plans as large group plans for small businesses/individuals. These plans would be exempt from the community rating and essential benefit requirements imposed on small group and individual plans.

Click here for a chart comparing the ACA, the AHCA and the Better Care Reconciliation Act.


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