BCRA and the Byrd Rule

The Better Care Reconciliation Act (BCRA) is being considered under a special legislative process known as budget reconciliation, which limits debate and allows a bill to pass with a simple majority. Reconciliation rules include the Byrd Rule requiring that bills passed through this process only include changes that directly affect the federal budget.

On July 21, the Senate Parliamentarian ruled that several provisions of the BCRA, as currently written, were in violation of the Byrd Rule and could be stricken from the bill if requested by a point of order from a member of the Senate. Notable provisions include:

  • the waiting period for individuals who violate the proposed continuous coverage requirement;
  • repeal of Essential Health Benefit requirements for Medicaid;
  • flexibility for states to set their own Medical Loss Ratio;
  • flexibility for states to expand the age rating ratio to 5-to-1, and
  • the prohibition on the use of tax credits to pay for plans that cover abortions.

The Parliamentarian is also considering whether proposed loosening of the 1332 guardrail requirements would be allowed under the Byrd Rule

Provisions that could be eliminated or are under consideration for possible Byrd violation are highlighted in our updated chart.

Senators may propose amendments that could fix the Byrd violations as they consider a vote on this bill this week. NASHP will continue to track and update as development occur.