The Bipartisan Health Care Stabilization Act of 2018 (BHCSA) would make several changes to health care laws. It would:
- Change the state innovation waiver process established by the Affordable Care Act (ACA),
- Appropriate a total of $30.5 billion for reinsurance programs or invisible high-risk pools in the nongroup insurance market,
- Appropriate funds for the direct payment for cost-sharing reductions (CSRs) through 2021,
- Allow any enrollee in the nongroup market to purchase a catastrophic plan, and
- Require some existing funding for operations in the health insurance marketplaces to be used specifically for outreach and enrollment activities in 2019 and 2020.
On net, CBO and the staff of the Joint Committee on Taxation (JCT) estimate that enacting the legislation would increase the deficit by $19.1 billion over the 2018-2027 period relative to CBO’s baseline. The agencies estimate that the legislation would increase the number of people with health insurance coverage, on net, by fewer than 500,000 people in each year from 2019 through 2022, compared with the baseline projection. Because enacting the legislation would affect direct spending and revenues, pay-as-you-go procedures apply.
CBO and JCT estimate that enacting the legislation would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2028.
The BHCSA would impose intergovernmental and private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA). CBO estimates that the costs of those mandates would fall below the annual thresholds established in UMRA for intergovernmental and private-sector mandates ($78 million and $156 million in 2017, respectively, adjusted annually for inflation).