Thursday, July 13, 2017

Health Care Legislation Update

from National FV:

Health Care Legislation - Update
The June 30 Update provided an explanation of the Senate version of legislation to "repeal and replace" the Affordable Care Act (ACA), the "Better Care Reconciliation Act" (BCRA).  After a Congressional Budget Office (CBO) analysis of the bill concluded that it would result in 22 million more uninsured individuals by 2026 compared to current law, Senate Majority Leader Mitch McConnell (R-KY), cancelled a vote he had planned to hold on the bill before the Independence Day recess.

As leadership had feared, Senators faced widespread constituent opposition to the bill during that recess. There are currently 11 Republican Senators who have said they oppose the bill in its current form - Senators Collins (ME), Murkowski (AK), Capito (WV), Moran (KS), Heller (NV), Hoeven (ND), Portman (OH), Johnson (WI), Paul (KY), Lee (UT), and Cruz (TX). (The last three believe it should go further in repealing the ACA; the others are concerned primarily about Medicaid cuts.)

Senate leadership plans to release two amended versions of the bill on Thursday  -- one including an insurance provision sought by Senators Cruz (R-TX) and Lee (R-UT), and one without it.  The CBO score of the Cruz-Lee provision, expected next week, will help to determine whether the bill ultimately will include it.

Reportedly, the amended bill will not make any significant changes in the Medicaid provisions; it would still subject Medicaid to per capita caps, although it may have the slightly higher inflation factor included in the House bill.  There are rumors that the amended bill will make some changes to the "carve-out" (from the Medicaid caps) for children who are blind or disabled (see the June 30 Washington Update), perhaps to more precisely define or expand the protected group.  Analysts say that this carve-out will not really protect the most vulnerable children from the negative impact of the caps, however.  See also Millions of Kids Fall Outside Senate Plan To Shield Disabled from Medicaid Cuts (Kaiser Health News, July 10, 2017).

A vote on the bill may take place as early as the end of next week. All Democrats oppose it.  Since there are 52 Republicans in the Senate and Vice-President Pence can break a tie, the bill will fail if three or more Republican Senators vote against it. Significantly, Senator Shelley Moore Capito (R-WV) has said that she is willing to cast the vote that kills the bill if it comes to that. 

The outlook at this point is uncertain.  Although it will be difficult for Senator McConnell to accommodate both ends of his party's spectrum, he is known to be a good negotiator, so it is possible that he will be able to get the bill passed. 
If the bill fails or is never brought to the Floor for a vote due to lack of support, then McConnell has said he may reach out to Democrats to develop legislation to stabilize the insurance marketplaces.  In fact, the Democratic leadership wrote a letter to McConnell this week, urging him to work with them on such legislation.  See Republicans debate Plan B if ObamaCare repeal fails

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