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The Better Care Reconciliation Act: Economic and Employment Consequences for States

This Article is by Source 

Publication Date: July 6, 2017
Authors: Leighton Ku, Erika Steinmetz, Erin Brantley, Nikhil Holla, Brian Bruen
Contact: Leighton Ku, Director, Center for Health Policy Research, Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University

Exhibit 1

Key Provisions of the Draft Better Care Reconciliation Act

Eliminates individual penalties for not having health insurance and penalties for employers that do not offer adequate coverage to employees. Imposes a six-month waiting period for nongroup coverage for people who have been uninsured for more than 63 days.
Lowers the ACA’s premium tax credits by reducing the benchmark used to compute the value of tax credits from 70 percent actuarial value to 58 percent. Establishes income criteria between zero and 350 percent of the federal poverty level and alters age structure, making net premiums paid somewhat larger for young adults, but much higher for older adults. Allows premiums to be five times higher for the oldest individuals, compared with younger people. Currently, premiums can be no more than three times higher.
Cost-sharing reductions to reduce deductibles and copayments for low-income people are retained in 2018 and 2019 but eliminated in 2020.
Makes numerous changes to Medicaid. Restricts state Medicaid eligibility expansions for adults, primarily by gradually ratcheting down federal matching rates from 90 percent in 2020 to between 50 percent and 75 percent by 2024.
Creates temporary funding for safety-net health services in states that did not expand Medicaid and eliminates reductions in Medicaid disproportionate share payments for nonexpansion states.
Restructures Medicaid funding based on per capita allotments rather than the current entitlement. States may adopt fixed block grants instead. Reduces the per capita cap inflation index to the overall consumer price index in 2025.
Creates a State Stability and Innovation Fund with short-term and long-term elements. Also creates a temporary program to help with the opioid crisis.
Terminates the Prevention and Public Health Fund.
Repeals numerous taxes included in the ACA, including Medicare taxes on investment income and on high-income earnings, taxes on health insurance and medical devices, and a tax on high-cost insurance (i.e., the “Cadillac tax”), and raises limits for health savings accounts and lowers the medical care deduction threshold.
Allows states to waive key insurance rules—like essential health benefits—by loosening Section 1332 waivers.

How will this affect Florida??


Every state except Hawaii experiences job and economic losses by 2026. The 10 states with the largest job losses by 2026 are: New York (132,000), California (117,000), Pennsylvania (110,000), Ohio (99,000), Michigan (86,000), Florida (78,000), Illinois (71,000), New Jersey (60,000), Massachusetts (54,000) and Indiana (39,000) 

​Appendix A1. State-Level Changes in Employment Due to the Draft Better Care ReconciliationAct, 2018 to 2026 (thousands of jobs) While the first two years shows an increase in jobs in 10 years the loss will be 78000 jobs. Will increase unemployment approximately 1% from 2017 numbers to 2026

​Status*     2018        2019        2020        2021        2022        2023        2024        2025        2026

​Florida      50.4         44.1         -2.7         - 22.7        -34.5        -54.5        -58.9        -64.6        -78.0

Appendix A1

Where are Florida Jobs now Click here Note jobs are in thousands

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(1) Do only 1 call or voicemail per week to each of your political representatives. If you call too frequently, you run the risk of being put on a “frequent caller” list in which you get ignored. Also, it’s generally more important to have 100 people leaving 1 voicemail per week than it is to have 20 people calling 5 times each week.

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Senator ______Please vote NO against the Senate Bill HR1628 which repeals Obamacare, taking healthcare from 23 million to finance tax breaks for billionaires and deserves a total shut down of regular order in the Senate if it passes.

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