U.S. Pain remains extremely concerned about the Senate’s proposed Better Care Reconciliation Act (BCRA) and its negative implications for the 100 million Americans living with chronic pain. The concerns are as follows:

  • While these reforms may make insurance cheaper for healthy individuals, their insurance will be significantly inferior, which will become a problem should they develop a chronic condition, like chronic pain. As the pain community knows, chronic pain can strike at any time.
  •  Meanwhile, people with chronic health conditions and older individuals will likely be subjected to higher costs—without any improvement in the quality of their insurance or even a decline in quality.
  •  Many individuals will lose access to low-cost insurance through Medicaid. But chronic pain can affect peoples’ ability to work. Through no fault of their own, they have difficulty affording health insurance and rely on Medicaid for care.

U.S. Pain recognizes that this is a highly sensitive and polarizing issue for many people. As such, it has put together a chart about some of the differences between the ACA and the BCRA.

Comparing key components of the ACA and BCRA



Individual mandate

Requires that everyone buy insurance coverage or pay a fee. (Some people may apply for an exception.) The mandate encourages healthy individuals to sign up for coverage, which helps offset the costs of coverage for unhealthy individuals.

Eliminates the mandate. Could lead to increase in costs for unhealthy individuals, as fewer healthy people will be paying for insurance and offsetting overall costs.

Employer mandate

Requires businesses with 50 or more full-time employees to offer health benefits.

Employers with 50 or more full-time employees no longer required to offer insurance coverage.

Medicaid coverage

Thirty-one states, plus the District of Columbia, expanded Medicaid coverage.

Medicaid would be cut by up to 26 percent in the next 10 years and would face steeper cuts starting in 2025. The bill does offer insurance subsidies to poor Americans who live in states that don’t offer Medicaid coverage, a group without good insurance options under the ACA. But these plans would likely have high deductibles.

People with pre-existing conditions

People with pre-existing conditions cannot be denied coverage or charged more for coverage.

Insurance companies would still unable to deny coverage on the basis of health. But, if an individual goes without coverage for 63 days and gets sick, they must wait six months before they apply for coverage.

People with disabilities

People with disabilities may qualify for Medicare and also Medicaid.

Services covered by Medicaid could be cut as federal funding to states declines over time.

The elderly

The elderly can be charged up to three times more for health insurance than their younger counterparts.

The elderly can be charged up to five times more than their younger counterparts.

Essential health benefits

Every insurance plan must offer 10 key treatment components—like prescription drugs, preventative services, and mental health care— called “essential health benefits.” While this did increase costs of coverage, it ensured high-quality benefits.

States can ask permission to reduce “essential health benefits.” And because the law places no out-of-pocket caps on nonessential health benefits, people who want those services would need to pay more for them.


 Individuals with an income level up to 400 percent of the poverty level, or about $48,000, can receive subsidies to help pay for coverage.

Would lower the annual income limit for receiving subsidies to 350 percent of the poverty level, or about $42,000 for an individual.


Whatever your perspective on politics and healthcare, U.S. Pain urges you to use the July 4 recess to attend town halls, parades and rallies, and continue calling your senators to tell them how this bill would impact you.


  1. https://www.cbo.gov/publication/52849
  2. http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&utm_source=hs_email&utm_medium=email&utm_content=53499938&_hsenc=p2ANqtz-8UhTwF2VLnZb-rVvAtFc269Novo3tm4CRacHsuWEmB9GjDhV4TmfE33T5-vWyrZrK-0G5FEMi99QTCdkCPxGfTmLJQTg&_hsmi=53499938
  3. https://www.nytimes.com/2017/06/22/upshot/shifting-dollars-from-poor-to-rich-is-a-key-part-of-the-senate-health-bill.html
  4. http://www.npr.org/sections/health-shots/2017/06/22/533942041/who-wins-who-loses-with-senate-health-care-bill