Actuaries Identify Critical Issues in Senate Health Care Bill

July 5, 2017

WASHINGTON—The American Academy of Actuaries is drawing policymakers’ attention to issues raised by the U.S. Senate majority’s health care legislation, the Better Care Reconciliation Act of 2017 (BCRA), in a letter sent to Senate leadership and copied to all other members of Congress and the nation’s governors.
“With legislation of this scope affecting millions of people and highly complex markets, assuring stable and sustainable markets is no simple feat,” said Academy Senior Health Fellow Cori Uccello. “We provided a nonpartisan, actuarial examination of the BCRA component-by-component, and drew lawmakers’ attention to critical issues.”

The letter from the Academy’s Individual and Small Group Markets Committee and Medicaid Subcommittee states that for a sustainable, stable individual health insurance market, lawmakers should focus on:
  • Continued funding of the cost-sharing reduction (CSR) reimbursements.
  • Enforcement of the individual responsibility penalty (the “individual mandate”).
  • Increased external funding through increased premium subsidies or to offset costs for high-cost enrollees.
  • Avoiding legislative or regulatory actions that could increase uncertainty or threaten stability.
The BCRA’s Medicaid funding approach affects Medicaid design elements, and the letter urges lawmakers to consider the legislation’s impact on the stability and long-term viability of the program, with attention to five key areas:
  • Approaches to setting state caps.
  • Treatment of Medicaid expansion populations.
  • Growth rate methodology.
  • Program flexibility provided to states.
  • Continuing actuarial soundness requirements.
 The letter is publicly available online at


The American Academy of Actuaries is a 19,000-member professional association whose mission is to serve the public and the U.S. actuarial profession. For more than 50 years, the Academy has assisted public policymakers on all levels by providing leadership, objective expertise, and actuarial advice on risk and financial security issues. The Academy also sets qualification, practice, and professionalism standards for actuaries in the United States.