View the July 20, 2017 draft of the Better Care Reconciliation Act (BCRA) here, and related section by section summary here. 
 
 View the July 13, 2017 draft of the Better Care Reconciliation Act (BCRA) here, and related section by section summaries here and here. 
 
 View the June 26, 2017 draft of the Better Care Reconciliation Act (BCRA) here. 
 
 REVISIONS TO THE BETTER CARE RECONCILIATION ACT 
 
 After extensive consultations across the Senate Republican Conference, below are the primary revisions to the Better Care Reconciliation Act (BCRA) discussion draft: 
 
 MORE HELP TO COVER OUT-OF-POCKET COSTS: 
 
 An additional $70 billion is dedicated to encouraging state-based reforms, which could include help with driving down premiums through cost-sharing, Health Savings Accounts (HSA), and other innovative ideas to help pay for health care costs. This is in addition to the $112 billion in funding already in the original bill. 
 
 HEALTH SAVINGS ACCOUNTS TO PAY FOR PREMIUMS: 
 
 In order to ensure that more people have financial support to pay for health care costs, a provision has been included in the bill that would, for the first time, allow people to use their HSAs to pay for their premiums. This is a policy that both the Joint Committee on Taxation (JCT) and the Congressional Budget Office (CBO) say will increase health care coverage. 
 
 ADDITIONAL RESOURCES TO COMBAT THE OPIOID EPIDEMIC: 
 
 With the opioid crisis hitting Americans in every state, an additional $45 billion is dedicated for substance abuse treatment and recovery. 
 
 MORE OPTIONS FOR AMERICANS TO BUY LOWER-PREMIUM PLANS: 
 
 Individuals who enroll in catastrophic plans would be eligible for the tax credit so long as they meet other tax credit eligibility requirements. Obamacare prohibited individuals enrolled in catastrophic plans from receiving a tax credit even if they met all other eligibility requirements. 
 
 Anyone in the individual market would be allowed to purchase a lower-premium health insurance plan, including Americans with their federal tax credit assistance. These plans are higher deductible plans that cover three primary care visits a year and have federal protections that limit an individual’s out-of-pocket costs. 
 
 TAX REVISIONS: 
 
 The new draft bill will not include any changes from current law to the net investment income tax, the additional Medicare Health Insurance (HI) Tax, or the remuneration tax on executive compensation for certain health insurance executives. 
 
 MEDICAID REVISIONS: 
 
 To allow for more accurate Disproportionate Share Hospital (DSH) related decisions and maximum benefit to states to assist in providing uncompensated care, the new discussion draft changes the DSH calculation from per Medicaid enrollee to per uninsured. 
 
 To improve management of vulnerable populations, states may apply for a waiver for the purpose of continuing and/or improving home and community-based services for aged, blind, and disabled populations. 
 
 If a public health emergency is declared, state medical assistance expenditures in a particular part of the state will not be counted toward the per capita caps or block grant allocations for the declared period of the emergency. 
 
 Expanded block grant option to allow states to also add expansion population under the block grant if they opt to do so. 
 
 Enhanced Focus On Higher Risk Individuals: 
 
 Creates a fund for the purpose of making payments to specified health insurance issuers for the associated costs of covering high risk individuals enrolled in the qualified health plans on the Affordable Care Act’s Individual Exchange. In order to qualify for such funds, an issuer must offer sufficient minimum coverage on the Exchange that remains subject to Title 1 mandates. Offering such coverage would enable the issuer to also offer coverage off the Exchange that would be exempt from certain Title 1 mandates. 
 
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 Overview of the Better Care Discussion Draft 
 
 Help stabilize collapsing insurance markets that have left millions of Americans with no options. Short-Term Stabilization Fund : To help balance premium costs and promote more choice in insurance markets throughout the country, this stabilization fund would help address coverage and access disruption – providing $15 billion per year in 2018 and 2019; $10 billion per year in 2020 and 2021. Cost-Sharing Reductions : Continues federal assistance – through 2019 –to help lower health care costs for low-income Americans. 
 
 that have left millions of Americans with no options. 
 
 Free the American people from the onerous Obamacare mandates that require them to purchase insurance they don’t want or can’t afford. Eliminates the individual and employer mandate penalties. 
 
 that require them to purchase insurance they don’t want or can’t afford. 
 
 Improve the affordability of health insurance , which keeps getting more expensive under Obamacare. Long-Term State Innovation Fund : Dedicates $132 billion, over 8 years, to encourage states to assist high-cost and low-income individuals to purchase health insurance. Tax Credits : Targeted tax credits will help defray the cost of purchasing insurance; these advanceable and refundable credits - adjusted for income, age and geography - will help ensure those who truly need financial assistance can afford a health plan. Health Savings Accounts : Expanded tax-free Health Savings Accounts to give Americans greater flexibility and control over medical costs; increased contribution limits to help pay for out-of-pocket health costs and expensive prescription medications.Additionally, for the first time, individuals will be able to use HSAs to pay for their premiums in excess of any tax benefit they already receive for the purchase of health care. Repeals Obamacare Taxes : Repeals costly Obamacare taxes that contribute to premium increases and hurt life-saving health care innovation, like the taxes on health insurance, prescription drugs, medical devices, and “high-cost” employer sponsored plans. Empowers states through state innovation waivers : Provides states additional flexibility to use waivers that exist in current law to free their health insurance markets from Obamacare regulations, reduce the cost of health insurance, and better allow customers to buy the health insurance they want. Allows the Department of Health and Human Services (HHS) to fast-track applications from states experiencing an Obamacare emergency. Support for State Opioid and Substance Abuse Crisis: Provides $45 billion in state grants to support treatment and recovery support services for individuals who have or may have mental or substance use disorders. 
 
 , which keeps getting more expensive under Obamacare. 
 
 Strengthen Medicaid for those who need it most by giving states more flexibility while ensuring that those who rely on this program won’t have the rug pulled out from under them. Targets Medicaid to Those Most in Need : In 2021, begins gradual reductions in the amount of federal Obamacare funds provided to expand Medicaid, restoring levels of federal support to preexisting law by 2024 while providing fairness for non-expansion states. New Protection for the Most Vulnerable : Guarantees children with medically complex disabilities will continue to be covered. Provides additional state flexibility to address the substance abuse and mental health crisis . Flexibilities for Governors: Allows states to choose between block grants and per-capita allotments for their Medicaid population beginning in 2020, with a flexibility in the calculation of the base year. Allows states to impose a work requirement on non-pregnant, non-disabled, non-elderly individuals receiving Medicaid. New Protections for Taxpayers: Curbs Medicaid funding gimmicks that drive up federal costs. 
 
 for those who need it most by giving states more flexibility while ensuring that those who rely on this program won’t have the rug pulled out from under them. ||||| Senate Republican leaders on Thursday unveiled a revised version of their bill to repeal and replace ObamaCare as they race toward a high-stakes vote next week. 
 
 
 
 The measure includes changes intended to win over additional votes, with leadership making concessions aimed at bringing both conservatives and moderates on board. (READ THE BILL HERE.) 
 
 
 
 But Senate Majority Leader Mitch McConnell Addison (Mitch) Mitchell McConnellTrump dismissed warnings from GOP leaders that party could lose House: report Gender and race shouldn't define your politics Trump’s budget chief talks spending clawback with key chairman MORE (R-Ky.) is facing a tough task in finding enough votes to pass the bill. Sens. Susan Collins Susan Margaret CollinsHow long must women wait? Senators hope Trump's next VA pick will be less controversial GOP moves to cut debate time for Trump nominees MORE (R-Maine) and Rand Paul Randal (Rand) Howard PaulPompeo vote won’t guarantee Democrats a win in November Overnight Defense: Uncertainty for VA after Trump pick withdraws | Veterans groups hope for more input | Pompeo confirmed as secretary of State | Mattis defends Iran deal as Trump deadline nears Overnight Cybersecurity: DHS chief eyes new ways to bolster cyber workforce | Dems grill Diamond and Silk | Senate panel approves bill to protect Mueller | Two-thirds of agencies using email fraud tool MORE (R-Ky.) appear to be firmly against the measure, and one other defection would kill the bill. 
 
 
 
 
 
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 Overall, McConnell appears to have shifted the revised bill more toward the conservatives than the moderates.Importantly, the bill largely keeps the Medicaid sections the same, meaning that deeper cuts to the program will still begin in 2025, and the funds for ObamaCare’s expansion of Medicaid will still end in 2024.The changes to Medicaid have emerged as a top concern for moderates such as Sens.(R-Ohio),(R-W.Va.) and(R-Alaska).The Congressional Budget Office (CBO) found that those Medicaid changes in the original bill would result in 15 million fewer people being enrolled in the program and cut spending by $772 billion over 10 years. 
 
 Collins said she still plans to vote against a motion to proceed to the bill, adding that the legislation should move through the normal committee process. 
 
 "My strong inclination and current intention is to vote no on the motion to proceed," Collins told reporters after leaving a briefing on the legislation. 
 
 "The only way I'd change my mind is if there's something in the new bill that wasn't discussed or that I didn't fully understand or the CBO estimate comes out and says they fixed the Medicaid cuts, which I don't think that's going to happen." 
 
 
 
 For the conservatives, the measure includes a version of an amendment from Sens. Ted Cruz Rafael (Ted) Edward CruzBritish toddler at center of legal battle dies after taken off life support Kushner expected to attend opening of Jerusalem embassy: CNN Handholding with South Korea aside, North Korea still has its nukes MORE (R-Texas) and Mike Lee Michael (Mike) Shumway LeeOvernight Cybersecurity: DHS chief eyes new ways to bolster cyber workforce | Dems grill Diamond and Silk | Senate panel approves bill to protect Mueller | Two-thirds of agencies using email fraud tool The Hill's 12:30 Report Senate panel approves bill to protect special counsel MORE (R-Utah) aimed at allowing insurers to offer plans that do not meet all of ObamaCare’s regulations, including those protecting people with pre-existing conditions and mandating that plans cover certain services, such as maternity care and mental healthcare. 
 
 
 
 Conservatives argue the change would allow healthier people to buy cheaper plans, but moderates and many healthcare experts warn that premiums would spike for the sick people remaining in the more generous insurance plans. 
 
 Cruz said he will support the bill so long as the provisions he sees as a priority are not changed in amendment votes on the floor. 
 
 "If this is the bill, I will support this bill," Cruz told reporters after a meeting of GOP senators. "Now, if it’s amended and we lose the protections that lower premiums, my view could well change." 
 
 Senate Republicans had vowed to not change the ObamaCare protections for people from being charged more based on their health in their bill, which is why the debate over the Cruz-Lee amendment has been heated. 
 
 A Senate GOP aide said Thursday it is possible that the Cruz amendment would not be analyzed by the CBO in time for the vote next week. It is possible the Department of Health and Human Services could provide an alternative analysis. 
 
 Lee cautioned that he was not involved in the changes to the proposal, including the amendment, and would have to review the new language before deciding whether to support it. 
 
 The bill does include new funding, $70 billion over seven years, aimed at easing costs for those sick people remaining in the ObamaCare plans. 
 
 However, the new measure does not boost the generosity of the tax credits, as some moderates wanted. It still replaces ObamaCare’s tax credits to help people afford insurance with a smaller, scaled-down tax credit that provides less assistance. 
 
 The Kaiser Family Foundation found premium costs would increase an average of 74 percent for the most popular healthcare plan, given the reduced assistance in the GOP bill. 
 
 The new measure will leave in place two ObamaCare taxes on the wealthy, in a departure from the initial bill. 
 
 That original measure lacked the support to pass, as more moderate members pointed to the CBO's finding that 22 million fewer people would have insurance over a decade. 
 
 Senate Republicans are now awaiting a new score of the revised legislation from the CBO, which could come early next week. 
 
 The new bill does include $45 billion to fight opioid addiction, but moderates such as Capito and Portman who hail from states where the problem is rampant have said they also want changes to the Medicaid portion of the legislation. 
 
 Portman said his position on the bill had not changed, but he did not give a clear answer on whether he'd back his party on the procedural vote. 
 
 “I'm the same position I've been in. I'm looking at the language,” he said. 
 
 Capito also said she doesn’t know whether she’ll vote to proceed to the bill. 
 
 “We have another meeting this afternoon on the Medicaid cuts,” she told reporters. “I need to really look at it, look at the score; I still have concerns.” 
 
 Asked if she would vote for the motion to proceed next week, she said, “Wait and see.” 
 
 In a change that could appeal to Murkowski, the bill sets aside 1 percent of the stability funds for states with costs that are 75 percent above the national average, which would benefit high-cost states like Alaska. 
 
 — This story was updated at 3:15 p.m. Alexander Bolton contributed. ||||| Vice President Mike Pence arrives on Capitol Hill in Washington, Thursday, July 13, 2017, to meet with lawmakers on the Republican health care bill which is under attack from within the party. (AP Photo/J.... (Associated Press) 
 
 WASHINGTON (AP) — Senate Republican leader Mitch McConnell released his new but still-reeling health care bill Thursday, bidding for conservative support by letting insurers sell low-cost, skimpy policies and reaching for moderates with added billions to combat opioid abuse and help states rein in consumers' skyrocketing insurance costs. 
 
 However, allowing insurers to offer bare-bones plans threatens to alienate moderates and perhaps other conservatives. And the measure retains cuts in Medicaid — the health insurance plan for the poor, disabled and nursing home patients — that moderate Republican senators have fought. 
 
 The legislation, the Senate GOP's plan for rolling back much of President Barack Obama's health care law, faces a do-or-die vote next week on which McConnell has no margin for error. Since Democrats uniformly oppose the effort, McConnell needs the votes of 50 of the 52 GOP senators to prevail, and two seem certain to vote "no" — conservative Sen. Rand Paul of Kentucky and moderate Sen. Susan Collins of Maine. 
 
 Conservative Sen. Ted Cruz, R-Texas, has demanded language letting insurers sell plans with minimal coverage, as long as they also sell policies that meet strict coverage requirements set by Obama's 2010 statute. Moderate Republicans have objected that the idea would make policies excessively costly for people with serious illnesses because healthy people would flock to the cheaper coverage. 
 
 Sen. Mike Lee of Utah, who'd partnered with Cruz, tweeted that the version they crafted wasn't put in the bill, adding, "Something based on it has, but I have not seen it or agreed to it." 
 
 Adding to the uncertainty, the Cruz provision appeared in the legislative text in brackets, meaning specific language was still being composed. That could give McConnell, Cruz and other conservatives time to work out a provision with broader support. 
 
 The retooled measure retains McConnell's plan to phase out the extra money 31 states have used to expand Medicaid under Obama's statute, and to tightly limit the overall program's future growth. Since its creation in 1965, the program has provided open-ended federal funds to help states pay the program's costs. 
 
 The rewritten package would add $70 billion to the $112 billion McConnell originally sought that states could use to help insurers curb the growth of premiums and consumers' other out-of-pocket costs. 
 
 It has an added $45 billion for states to combat the misuse of drugs like opioids. That's a boost over the $2 billion in the initial bill and an addition demanded by ok 
 
 Republicans from states in the Midwest and Northeast that have been ravaged by the drugs. 
 
 To help pay for the added spending, the measure would retain three tax increases Obama's law slapped on higher- earning people to help finance his law's expansion of coverage. Under the current statute, families earning more than $250,000 annually got a 3.8 percent boost on their investment income tax and a 0.9 percent increase in their payroll tax. Obama also imposed a new tax on the salaries of high-paid insurance executives. 
 
 The revised bill would also allow people to use money from tax-favored health savings accounts to pay health insurance premiums, another favorite proposal of conservatives. 
 
 McConnell's new bill offered only modest departures from the original version, which he yanked off the Senate floor two weeks ago to avoid certain defeat at the hands of a broad range of unhappy Republicans. 
 
 The reworked measure's key elements remain. It would ease Obama's requirements that insurers cover specified services like hospital care, erase Obama's penalties on people who don't buy coverage and make federal health care subsidies be less generous. 
 
 In an interview Wednesday with the Christian Broadcasting Network's "The 700 Club," President Donald Trump said he will be "very angry" if the Senate fails to pass the health care measure and said McConnell must "pull it off." 
 
 Paul told reporters the revised measure has nothing "remotely resembling repeal." 
 
 Collins has long complained the measure will toss millions off coverage. Spokeswoman Annie Clarke said Collins would vote "no" next week "if the Medicaid cuts remain the same" as those that have been discussed. 
 
 Besides Paul and Collins, other Republican senators have also been noncommittal on whether they will back McConnell's bill next week, including Tim Scott of South Carolina and Rob Portman of Ohio. 
 
 ___ 
 
 AP reporters Ricardo Alonso-Zaldivar and Erica Werner contributed to this report.
– President Trump said he'd be "very angry" if senators fail to repeal ObamaCare as promised, and GOP leaders have just taken a step in their quest to quell that anger. The second draft of the Better Care Reconciliation Act was released on Thursday with revisions aimed at getting 50 of the Senate's 52 GOP votes. The Congressional Budget Office should score the bill early next week, and next week should also see a vote. The Hill's take: "Overall, [Mitch] McConnell appears to have shifted the revised bill toward the conservatives, without giving the moderates much of what they want." The AP sees "only modest departures" from the original. Indeed, Medicaid cuts are mostly unchanged, to the likely displeasure of moderates. This means the funding that 31 states have used to expand Medicaid under ObamaCare ends in 2024, and further cuts follow the next year. Five things that were changed: Ted Cruz's amendment appears, sort of. He, along with Sen. Mike Lee, proposed allowing insurers to offer bare-bones plans as long as those insurers also sell at least one policy that conforms to ObamaCare requirements. What's included is based on their version, though the AP notes it appears in brackets, meaning the language hasn't been finalized. The "stability fund" grows from $112 billion to $182 billion. This is the money states could dole out to help tamp down premiums and other costs. Opioids get more funding, to the tune of $45 billion, up from the $2 billion in version one. Two ObamaCare taxes on the wealthy are back. Currently, families earning more than $250,000 a year see a 3.8% increase in their investment income tax and a 0.9% bump in their payroll tax. The taxes had been removed in version one. Premiums could be paid for using money from pre-tax health savings accounts, an approach conservatives favor.