Who Gains and Who Loses under the Better Care Reconciliation Act

The proposed Better Care Reconciliation Act (BCRA) would repeal large portions of the Affordable Care Act (ACA), including most of its sources of revenue, and it would significantly change the Medicaid program and the private nongroup insurance market. We use the Urban-Brookings Tax Policy Center Microsimulation Model and the Urban Institute Health Policy Center’s Health Insurance Policy Simulation Model to analyze the effects of the bill and to allocate changes in taxes and federal health benefits across families grouped by income. We find that the BCRA’s changes to federal taxes and health care benefits would be very regressive: taking both tax reductions and benefit reductions into account, the average high-income family would be significantly better off, and the average low-income family would be significantly worse off. The average family with less than $10,000 of income in 2026 would be $2,550 worse off, a net reduction of more than 60 percent of the family’s income. The average family with more than $200,000 of income in 2026 would be $5,420 better off, a net increase of 1 percent of the family’s income. Most of the gain for high-income families would be concentrated among families with incomes above $1,000,000. The average gain for this group would be $49,000, a net increase of 1.5 percent of income.