Senate Healthcare Bill Summary

Better Care Reconciliation Act of 2017 – Repeal and Replace ACA


Senate Majority Leader Mitch McConnell (R-KY) unveiled the Better Care Reconciliation Act of 2017 (“Better Care Act”), their plan to repeal and replace the Affordable Care Act (ACA), on June 22, 2017. Thirteen Republican senators developed the Better Care Act behind closed doors, and Senate GOP leadership has signaled there’s no intention to hold any public hearings, mark ups, or committee meetings before taking a vote.

  • The Senate GOP is pushing to hold a vote before the July 4 recess.
  • A Congressional Budget Office (CBO) score will be released early next week, leaving only a few days for senators to review before a vote.
  • Budget reconciliation rules allow the Senate to pass the bill with a simple majority. Right now, the GOP can only lose two votes. Experts anticipate mass deal-striking to give the Trump administration its first legislative win.

Impact to Michigan and Health Centers

The CBO estimates the Better Care Act will result in 22 million Americans losing coverage and nearly $800 billion cut from Medicaid over the next decade. Additionally, the legislation does not include a fix to the Health Center Funding Cliff. If the Better Care Act became law, health centers would likely become primary providers to newly uninsured individuals, straining already tight budgets. From a consumer perspective, the loss of insurance — either through Medicaid or the Marketplace — would lead to more out-of-pocket costs and an increase in Sliding Fee Scale patients. All of this without the security of knowing the Health Center Program will remain funded at its current level.

Key Policy Provisions

The Better Care Act retains the income-based subsidies available to individuals on the individual market, but significantly waters them down. It also would make it easier for insurers to charge individuals with pre-existing conditions more for their coverage. Many of the major changes to the ACA would be delayed until 2019, but the bill fundamentally changes Medicaid as we know it. The Better Care Act would:

  • Change Medicaid to a per capita caps program and phase out Medicaid expansion from 2020 to 2024 – states also have the option to choose a block grant for their Medicaid program;
  • Eliminate the individual mandate and the employer mandate for larger companies;
  • Allow states to impose work requirements for non-disabled, non-elderly, non-pregnant adults as a condition of Medicaid coverage;
  • Cap eligibility for premium tax credits at 350% FPL and reset the “median cost benchmark plan” to coverage less than current bronze plans under the ACA; and
  • Repeal many of the taxes used to pay for the ACA, giving a tax break to the wealthiest Americans.


Although the ACA has been criticized for premium, deductible, and copay increases the Better Care Act will only make these worse.

  • Low-income individuals and families would pay higher premiums for bigger deductibles and less generous benefits packages.
  • The Better Care Act doubles down on Medicaid cuts, ending the program as we know it.

The Better Care Act will create major access barriers to millions of people. Thus far, the entire health care industry opposes both the AHCA (House) and the Better Care Act (Senate). Despite this opposition, the lawmakers are moving forward. Advocates must keep the pressure on Congress. Senator Peters and Senator Stabenow need to know that we support them in their fight against health care policy that is bad for Michigan and America. We need to make our lawmakers understand the true, harmful impact this would have on Michigan residents. We can do that with your help.