After weeks of secrecy and speculation about the content of the Senate’s health care bill, Senate Republicans released a “discussion draft” of their bill on Thursday. The bill, titled the “Better Care Reconciliation Act of 2017” or BCRA, is the Senate’s response to the bill passed by the House of Representatives in May. While the bill is likely to be amended before it moves to a vote before the Senate (with a vote possibly coming as early as next week), the discussion draft provides insight into the health care system changes that are likely to result if the bill (or something similar) ultimately becomes law.

Among other things, the Senate bill:

  • Limits the eligibility of individuals for tax credits used to purchase insurance in the individual market;
  • Eliminates insurance mandates;
  • Allows states to seek waivers including waivers in the Medicaid program for certain requirements, and including waivers for the requirement that all insurance plans cover “essential health benefits;”
  • Eliminates Medicaid expansion and fundamentally alters the federal funding construct of the Medicaid program; and
  • Repeals a number of the tax expenditures that were included in the Affordable Care Act (ACA), including the Cadillac tax, the tax of prescription medication, the medical device excise tax, and the health insurance tax.

While the Congressional Budget Office and Joint Tax Committee have yet to release their assessments of the bill, it’s safe to say these changes, if implemented, will have a significant impact on the American health care system.