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  • New Version of Senate Health Care Bill Remains Problematic for APTA

    The latest version of the US Senate's health care legislation may include tweaks intended to please critics of the earlier draft, but the changes aren't enough to alter APTA's position that the bill would decrease access to care for millions of Americans.

    The revised Better Care Reconciliation Act (BCRA) is the Senate's second attempt to rollout a bill that would repeal and replace many provisions of the Affordable Care Act (ACA). The original version of the legislation was withdrawn just before the Senate's July 4th recess, when it became evident that the bill didn't have enough support to reach the floor for debate.

    The new version attempts to woo conservative opponents of the bill by weakening the ACA's requirements around health insurance and mandated essential health benefits (EHBs) that include habilitation and rehabilitation services. In a nod opponents concerned about the BCRA's effect on Medicaid, drafters of the bill also backed off proposals to eliminate some of the taxes associated with the ACA, slowed the phase-out of Medicaid expansion, and included more money for opioid addiction treatment and research.

    Technically, the provisions around EHBs—one of APTA's major areas of concern—are different from the first version of the bill. Rather than allowing states to opt for waivers of requirements that insurance policies contain the EHBs, the new version of the BCRA would allow insurance companies to offer stripped-down policies that don't include EHBs, so long as they offer at least 1 policy option that includes the required benefits. Individuals could choose cheaper low-cost, low-coverage options or more expensive policies with full EHB coverage.

    In practice, however, the results would be the same, according to Justin Elliott, APTA's vice president of governmental affairs.

    "Even with these changes, our concern remains," Elliott said. "Under this legislation, many Americans would find themselves with health care insurance that limits access to needed care, including physical therapist services. However we will continue our discussions with Capitol Hill as the legislative language evolves.”

    The bill's Medicaid provisions include a phase-out of federal funding for Medicaid expansions by 2024, and ties any later increases to inflation rates. APTA and many other organizations remain opposed to phase-out plans as presented so far, given that the changes have the potential to leave millions of Americans uninsured. The Congressional Budget Office will evaluate the entire bill and is anticipated to have estimates on uninsured rates and overall costs early next week.

    For APTA, the central concerns it voiced in its statement on the House of Representatives health care bill haven't changed. During the House debate on the bill, called the American Health Care Act, the association wrote that the provisions set the stage for a health care system that would create "unneeded barriers to care and reduce the access to care for millions of Americans." The association reiterated its position in a May letter to senators as they began their own work on health care legislation.

    Throughout both the House and Senate drafting and debate, APTA has continued to advocate for patient access to appropriate care and participated in a recent briefing on Capitol Hill educating lawmakers on the importance of habilitation and rehabilitation.

    Late this week, it remained unclear whether the Senate bill would be brought to the floor for debate.

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