“Do They Play Omaha In Nevada?”: Accommodating State-Specific Health Reform Concerns In BCRA

July 18, 2017

Just last week, Senate negotiators released the latest changes to their health reform bill (i.e. Better Care Reconciliation Act (BCRA). The new amendments include many State-specific ‘fixes” (see The Federalist blog piece authored by Christopher Jacobs which details many of these provisions).  One of the biggest changes is an accommodation in establishing the baseline year of the per capita caps (PCC) model for “late expanding States” (i.e. between FY2015 and FY2016). These States include Minnesota, Alaska, and Louisiana amongst others.

These States will be able to select less than 8 consecutive quarters in establishing their baseline (i.e. 8 consecutive quarters being the requirement for other States) but no less than 4 consecutive quarters. Besides the PCC provision, the new BCRA language includes money for South Dakota (i.e. Indian health money), Alaska (i.e. Medicaid hospital funding), etc. as well as $45B for treating and researching the opioid crisis, which is particularly acute in States like West Virginia.

During the hiatus in legislative activity related to BCRA (i.e. no procedural votes or new CBO score), additional State “fixes” are also being floated.  According to reports in Politico, The Trump administration is pitching a waiver proposal to Nevada as a way to bring Republican Gov. Brian Sandoval on board with BCRA.

The proposal broadly aims to move Medicaid expansion enrollees into the private insurance market, where they could use subsidies to help pay for premiums. Additional funding would be provided to further limit their costs. Interestingly, just recently, the Democratic-led state legislature in Nevada passed a bill (that was vetoed by Governor Sandoval) that would have allowed anyone to purchase a Medicaid-like policy, regardless of their income.

The bill called for the state to create the Nevada Care Plan, which would have been separate from the state's Medicaid program but offered nearly all the same benefits. Finally, with approximately $150M “left” to be spent (the difference in deficit savings between the House and Senate bills) on other State-specific solutions, it is possible additional tweaks to BCRA may be forthcoming.