How BCRA 2.0 would impact enrollee costs, according to your age and income

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On July 12, we examined how the Better Care Reconciliation Act of 2017 (BCRA) discussion draft would affect people’s total spending on covered health care services, with the goal of providing a full picture of health care costs for consumers purchasing coverage in the individual market under the BCRA as opposed to current law. The analysis that follows updates this examination for the revised legislation made public on July 20 (“BCRA 2.0”).
There are two primary differences between the two versions of the BCRA that impact this analysis:
More money is dedicated to the law’s Patient and State Stability Fund. Specifically, BCRA 2.0 allocates an additional $15.2 billion for this purpose in 2026, the relevant year for our analysis. The Congressional Budget Office (CBO) estimates that some of this money would be dedicated to reducing premiums, some to reducing enrollees’ out-of-pocket spending, and some to “other” purposes. (Our analysis accounts for the resulting reductions in premiums. Unfortunately, due to data limitations, we cannot account for the reductions in out-of-pocket spending, but accounting for these amounts would not change our qualitative findings.)
BCRA 2.0 newly allows health savings accounts (HSAs) to be used to pay health insurance premiums in the individual market.
As in our earlier analysis, we find that the BCRA 2.0 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.


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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 CBO’s estimates of the BCRA. We focus on the year 2026 because CBO provides estimates in that year for individual ...

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