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How the BCRA Would Impact Enrollee Costs, According to your Age

Loren Adler and Paul Ginsburg find that the BCRA would increase total costs for lower-income enrollees in all age groups.


Editor’s Note:  This analysis is part of USC-Brookings Schaeffer Initiative on Health Policy, which is a partnership between the Center for Health Policy at Brookings and the University of Southern California Schaeffer Center for Health Policy & Economics. The Initiative aims to inform the national health care debate with rigorous, evidence-based analysis leading to practical recommendations using the collaborative strengths of USC and Brookings.


By: Loren Adler and Paul Ginsburg

Much attention has focused on how the recently-introduced Senate Republican health care bill – the Better Care Reconciliation Act of 2017 (BCRA) – would impact health insurance premiums, both before and after accounting for lower subsidies, and patient cost-sharing in the individual market. In this analysis, we examine how the law would change people’s total spending on covered health care services, to provide a full picture of health care costs for the average consumer under the BCRA as opposed to current law.

We find that the BCRA would increase total costs for lower-income enrollees in all age groups. For higher-income enrollees, older enrollees would generally experience increases in costs, while younger enrollees would experience reductions in costs, though these reductions would be smaller than the increases experienced by older enrollees.

To construct estimates of the total health care costs (premiums plus out-of-pocket cost-sharing) that an individual market enrollee at different ages and incomes could expect to pay in 2026, on average, under the BCRA and under current law, we rely upon Congressional Budget Office (CBO) estimates of the BCRA. We focus on the year 2026 because CBO provides estimates in that year for individual market insurance premiums at different ages, under both the BCRA and current law. CBO highlights 2026 because it is the last year in the 10-year budget window within which they provide estimates and because it illustrates that law’s effects when fully in effect.

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