Health Care Legislation - Update
As outlined in the last Update (July 12), the Senate version of a bill to "repeal and replace" the Affordable Care Act (ACA) has gone through many changes intended to attract the votes of enough Senators to pass it. After a couple postponements and apparent deaths, the bill was revived and finally brought to the Senate Floor on Tuesday, July 25. For procedural reasons, what was presented to the Senate was actually the House bill, the American Health Care Act (S. 1628). In the Senate, a bill cannot be taken up without a "Motion to Proceed." Organizations and individuals opposing the bill lobbied Senators to oppose the Motion, which would have killed efforts to repeal and replace the ACA. But the Motion passed when Vice-President Pence broke the 50-50 vote. Two Republicans - Senators Susan Collins (R-ME) and Lisa Murkowski (R-AK) -- joined all Democrats in voting against it.
To simplify a complicated procedural process, two major amendments "in the nature of a substitute" were offered to the bill. One - the "ObamaCare Repeal Reconciliation Act" (ORRA), promoted by Sen. Rand Paul (R-KY) - would have repealed key parts of the ACA, effective amendment was defeated by a vote of 45-55. Republican Senators Lamar Alexander (TN), Shelley Moore Capito (WV), Susan Collins (ME), Dean Heller (NV), John McCain (AZ), Lisa Murkowski (AK) and Rob Portman (OH) joined all Democrats in voting no., without any replacement. That
The other substitute amendment was a version of Sen. McConnell's Better Care Reconciliation Act (BCRA) -- which would repeal or amend key parts of the ACA, (e.g., eliminating the individual and employer mandates, phasing out the Medicaid expansion, and reducing premium subsidies), and cap and cut federal Medicaid payments to states - along with a provision requested by Sen. Ted Cruz (R-TX) to allow insurers to sell some plans that do not comply with ACA standards; and a provision requested by Sen. Rob Portman to (roughly speaking) provide additional funds to reduce cost-sharing obligations of low-income consumers, and to permit states to use Medicaid funds to for private coverage. A vote on this substitute amendment failed 43-57 night, with Republican Senators Collins (ME), Graham (SC), Paul (KY), Corker (TN), Heller (NV), Moran (KS), Murkowski (AK), Cotton (AR), and Lee (UT) joining all Democrats in opposition. According to the nonpartisan Congressional Budget Office(CBO) the BCRA (without the Cruz and Portman provisions) would cause 15 million more people to be uninsured in 2018, compared to current law, 19 million more in 2020, and 22 million more in 2026.
Other amendments have been and will be offered, including ones by Senator Donnelly (D-IN) and Casey (D-PA) to refer the bill to committee to eliminate provisions that weaken Medicaid or would hurt people with disabilities, respectively. Both failed, as did an amendment by Sen. Heller (R-NV) - a "Sense of Senate" that Medicaid expansion is a priority and that Obamacare must be improved. Senator McCain also plans to offer Medicaid-related amendments. Even if these pass, however, they may be superseded by whatever substitute amendment Sen. McConnell offers at the end of the "vote-a-rama" - quick votes on amendments with only minutes of debate on each.
The situation is fluid, but at the moment it is expected that Senator McConnell will offer a final substitute amendment that will include (and exclude) provisions allowing him to get the 51votes needed to pass it, including Vice-President Pence's if needed. This so-called "skinny bill" may simply eliminate the ACA's individual and employer mandates and its medical device tax, and probably would not include any Medicaid provisions. The point of passing this bill would be to allow negotiations to commence with the House in a formal "conference committee" or on an informal basis. Most likely, the House bill would serve as a template for the compromise legislation, making it likely that a House-Senate compromise - if one can be reached - would include the House bill's caps and cuts in Medicaid payments to states.
, Democratic Leader Senator Chuck Schumer (D-NY) announced that Democrats would not offer any amendments until Senator McConnell reveals what will be in the bill.
At this point, it is predicted that the final vote will occur in the early hours of morning (middle of night). To see the latest developments, see Live coverage: Senate debates repealing ObamaCare (from The Hill, updated as events unfold).
(For a general explanation of the reconciliation process, see Budget Reconciliation Basicsfrom the American Action Forum. For an explanation of this particular reconciliation process in the Senate, see Who Knew Senate Health Bill Debate Could Be So Complicated? (Kaiser Health News, July 25, 2017)
- Senate GOP effort to shield disabled from Medicaid changes would leave many kids on the outside, Washington Post, July 9, 2017 (Meg Comeau and Janis Guerney quoted)
- Millions Of Kids Fall Outside Senate Plan To Shield Disabled From Medicaid Cuts, Kaiser Health News, July 10, 2017 (longer version of Washington Post article; also quotes Cara Coleman)
- Parents of Medically Fragile Children Take Stand against Medicaid Cuts, Georgetown University Health Policy Institute, July 13, 2017