In the latest round of the GOP Health Care saga, the Senate has released an updated discussion draft of their Better Care Reconciliation Act. Under the Affordable Care Act (a.k.a. Obamacare), a person with a chronic illness like Type 1 Diabetes is able to get a health insurance policy at the same premium with the same benefits as a person who has not yet had their pre-existing condition. Cruz is calling his amendment “a consumer freedom option”. If you value your access to health insurance, be very clear that what the Cruz amendment allows, is for health insurance companies to offer insurance plans that don’t adhere to all the ACA’s regulations and would not have to provide coverage for the ten essential benefits. This will lead to skyrocketing premiums as healthier individuals would most likely opt for the reduced coverage leaving those with chronic illnesses left in plans that provide the benefits necessary for them to live. The Cruz amendment according to major insurance company groups will destabilize the individual marketplace. And due to turning the individual marketplace into a high risk pool, premiums would increase significantly and insurance companies would possibly choose to leave the marketplace. Yes, even insurance companies don’t like this amendment. And while we’ve all had issues with insurance company claims, insurance companies need to write insurance policies to stay in business. The individual mandate would also be repealed, which would lead to fewer health people enrolling in the individual marketplace and helping to balance the risk pools. Subsidies would also only be available to low- and moderate income individuals earning less than $42,000 (in 2017). Those subsidies would only be available on plans with higher deductibles. For those who make more than $42,000 a year, they would have to pay these higher premiums without subsidies and have higher deductibles, therefor increasing the net out of pocket cost even more. "If there were a Joy of Cooking for insurance, this would be the perfect recipe for destabilizing the market and turning the marketplaces into high-risk pools," said Larry Levitt, senior vice president at the Kaiser Family Foundation. The old pre-ACA high risk pools offered limited coverage, had higher premiums and had fixed enrollment numbers, so even if you were fortunate enough to participate in one, you had higher premiums and less coverage. In terms of the originally proposed Medicaid cuts, there is no change. Funding for Medicaid expansion will be eliminated by 2021. Two key taxes that were originally going to be repealed are going to be left in place. These are the 3.8% tax on investment income and 0.9% Medicare payroll tax on those with higher incomes, $200,000 for individuals and $250,000 for married couples who file jointly. So while the less well off will still be harmed, at least there’s no tax break for the wealthy. The tax on medical device makers would be still be repealed. An additional $45 billion will go towards funding substance abuse treatment and recovery. This is strictly a measure to try to get more Senators to vote for the bill. The one positive is that there will now be $182 billion in funding for a state stabilization fund rather than the original $112 billion. The goal is reduce premiums for whose who are sick. However, it would be up to each state to determine how to use the funds. States could choose to provide assistance to reduce premiums and out-of-pocket costs for the sick or subsidizing insurers who have many high cost enrollees. On version 1.0 of the BCRA, the American Academy of Actuaries felt that while it would stabilize insurance markets, it would also cause decreased enrollment and rising costs. The good news is that more than half a dozen Republic and Democratic seniors have discussed alternatives to the BCRA. It seems that some Senators do actually want to do the right thing. These Senators recognize that it is important to provide stability and certainty to the health insurance markets. Currently, Senate Majority Leader, Mitch McConnell is planning for a vote next week. 50 votes are required for the bill to pass and as there are 52 republicans, if just 3 vote no, the bill will not pass. Also, the Congressional Budget Office will be releasing an updated score on Monday, so we’ll know how many millions of people will still lose their health insurance coverage. There is also some question as to whether the Senate Parliamentarian will allow some portions of this bill to remain. GOP Senators Bill Cassidy and Lindsey Graham have proposed an alternative bill that would essentially keep most components in place and send them to the states to control rather being controlled at the federal level. And they have brought up the need for a bipartisan bill. What’s really being missed in all of these discussions are increases in health care costs and especially with medications. Insulin’s list price has increased by 270 percent over the last decade. If our health care system were switched to a legitimate, transparent pricing system like most other businesses, it is estimated that annual health care costs would be reduced by 1/3. Advocacy can and does make a difference. Make your voice heard. Tell your Senators to vote no on the BCRA and let them know how critical health insurance is to all Americans. Please continue to share “Fair Health Insurance for All” petition. Tony Steuer