The Cruz Amendment: In or Out? (Hot or Not?) 

A burning question about possible changes to the Senate Republicans’ “Better Care Reconciliation Act” – Would leaders include the controversial “Cruz Amendment”? – has been answered.  

If you’ve been following the news on the ongoing negotiations among GOP senators over how to draft a bill that can garner the needed 50 votes, you will surely have heard about the amendment, which would allow insurers offering ACA-compliant individual coverage on a public exchange to offer ACA-noncompliant coverage off the exchange. The amendment is a serious effort to win over conservatives by reducing the cost of health care coverage for many Americans.  But many moderates worry that it would gut protections for people with pre-existing conditions and destabilize insurance markets.

Backers of the Cruz proposal contend that ACA requirements raise premium costs by mandating the types of benefits covered and that providing access to less rich plans will lead to lower premiums for many, especially the young and healthy.  Opponents counter that segmenting the risk pool this way will send costs skyrocketing for older, sicker Americans.

Cori E. Uccello, a senior fellow at the American Academy of Actuaries told the New York Times: “People who have higher health care needs and need more comprehensive coverage would choose A.C.A.-compliant plans. ... People who are healthy now would tend to choose noncompliant plans with really basic benefits. People who want or need more comprehensive coverage could find it out of their reach, because it might become unaffordable.”

To counter these concerns, the new bill also adds new money to help those insurers cover the cost of high-risk individuals and stabilize premiums so that they don’t become unaffordable.

Senate Republican leaders expect the Congressional Budget Office will have new projections of BCRA’s potential cost and coverage effects as early as Monday.  Those estimates will be critical in helping leaders decide what changes they’ll make to the bill before bringing it to the Senate floor next week.  Whether the Cruz Amendment will stay in the bill and in what form is a big question, and one we don’t yet have the answer to.

The bill currently does not appear to have enough support to pass, although GOP leaders hope 50 senators will at least agree to proceed to a possible vote. If that happens, leaders will likely continue to negotiate changes during floor consideration. Both Republicans and Democrats are expected to offer many amendments before voting on a final measure. Since this process could take weeks, the Senate has delayed the start of its planned August recess.

So stay tuned -- we’ll be watching closely and posting updates here.