Experts say the new version of the Senate healthcare bill will be bad news for the old, poor, and sick

Republicans in the Senate on Thursday released an updated version of the Better Care Reconciliation Act, their plan to overhaul the US healthcare system.

Among the changes to the new bill: More funds would be set aside for the opioid crisis, and a provision would allow people to pay for premiums using a health savings account.

The update also includes a modified version of an amendment offered by Sen. Ted Cruz and Sen. Mike Lee that critics say could make plans with adequate coverage unaffordable to those who have certain medical conditions.

Experts, however, are not convinced the changes are enough to make a difference on the Congressional Budget Office score that the bill originally received. The analysis said the legislation would leave 22 million more Americans without insurance. The CBO also estimated that cuts to Medicaid would hit $US772 billion by 2026.

“This is still a bill that will result in very large reductions in insurance coverage and reductions in the quality and affordability of the insurance coverage for many people who retain coverage,” Matthew Fiedler, a fellow at the Brookings Institute, told Business Insider in an email.

Additionally, provisions in the bill similar to an amendment put forth by Sen. Ted Cruz will likely increase costs for people with preexisting conditions.

“The Cruz amendment will shift the premium burden toward sicker people and partially offset those premium increases via an infusion of additional federal money,” Fiedler said.

Undermining the CBO

It likely won’t be a surprise to Senate Republicans leadership if the CBO score is unchanged. Republican senators have been trying to undermine the CBO’s credibility over the past few days, Craig Garthwaite, a professor of strategy at the Kellogg School of Management at Northwestern University, told Business Insider.

For the most part, Garthwaite said, the revisions of the bill appeared to target individual senators, such as the Cruz amendment. Another provision sweetened the deal for Alaska Sen. Lisa Murkowski, who would see a guarantee of funding for her state to combat high premiums after she has been vocal in opposition to various elements of the bill.

But beyond those changes in the periphery, there aren’t a ton of “principle changes,” Garthwaite said. The proposal still includes deep cuts to the Medicaid program. That’s in part because many many Republican senators support the changes, and the hope might be to get moderate senators on board without touching the Medicaid provisions.

Even so, the updates to the bill could have some major consequences. The Cruz amendment, in particular, would allow plans to exist that don’t comply with two regulations set up under the Affordable Care Act: community rating and essential health benefits. The latter could have a big impact on preexisting conditions.

Because some health plans wouldn’t have to necessarily adhere to the community rating, and essential health benefits, those that do would receive funding to offset the higher premiums that would result relative to the plans that don’t cover the regulations. Whether that funding would be enough to make the plans affordable remains to be seen.

“The stabilisation funds may help bring down premiums in the short-term, but the funding is only temporary,” Cynthia Cox, an associate director at the Kaiser Family Foundation, a nonpartisan health-policy think tank told Business Insider in an email. “What happens when the money runs out?”