Dizzying Week in Congress Leaves Future of Health Care Bill Even More Unclear

The week of July 17th was a roller coaster ride for those following the effort in the Senate to repeal and replace the Affordable Care Act (ACA). As of last week, it had been expected that Senate Majority Leader Mitch McConnell (R-KY) could move the Better Care Reconciliation Act (BCRA) to a vote, but the unexpected absence of Senator John McCain (R-AZ) due to a medical condition contributed to that plan falling apart, and teed up a series of events which leave the future of the BCRA unknown. (Senator McCain has been diagnosed with an aggressive form of brain cancer. It is not known at this time when he will be back at work.) Here’s the overview and where the health care bill stands as of the writing of this article.

 

Two bills in play: With support for the BCRA flagging and a growing number of Senators saying they would not support the bill or a motion to proceed on it, on July 18th McConnell floated the idea of putting up a straight repeal of the ACA up for a vote (the legislation is titled the Obamacare Repeal Reconciliation Act (ORRA)). The “repeal and delay” strategy was immediately rejected by four moderate Republican Senators (Collins, Murkowski, Capito, and Portman), with other Senators also speaking strongly against taking that bill up. If McCain is not available for a vote, assuming all other Senators do vote and all Democrats vote against a motion to proceed, Republicans can only lose one vote to pass a measure 50 to 49. If two Republicans defect, the motion to proceed would fail. Despite these long odds, McConnell said that he would put the motion to proceed up to a vote next week anyway. 

 

The Trump Administration: President Donald Trump hosted several gatherings at the White House in an attempt to persuade Republicans to vote in favor of the bill, though exactly which bill Trump supports has been difficult to discern. On Wednesday he told Senators they should not leave town without passing the BCRA. Later, he said Congress should vote to fully repeal the bill. A third option he seemed to endorse was to repeal and replace, whether by the BCRA or by some other legislation. 

 

CBO Scores: The CBO released two reports this week, one on the current version of the BCRA, and one looking at a full repeal of the ACA without a replacement. The latest estimates on the BCRA are similar to prior CBO estimates, with a reduction in Medicaid of approximately $784 billion over ten years (compared to a high of $880 billion and a low of $772 billion), and resulting in 22 million fewer people with insurance. The estimate for the repeal without a replacement bill (ORRA) would not impact traditional Medicaid, but would end the Medicaid expansion starting in 2020, as well as the Community First Choice Option HCBS program. CBO estimates that ORRA would result in 32 million fewer people with insurance, and on average double premiums by 2026. 

 

At this time, it is expected that there will some sort of vote happening next week, though whether it is the BCRA, the ORRA, or some as-of-yet unknown legislation is yet to be determined. What is clear is that negotiations will continue right up until a vote, with intense pressure applied to moderate Republican Senators who have said they oppose or might oppose the BCRA. ANCOR will continue to push out action alerts and encourage members, especially those in key states, to call their Senators often to urge them to oppose any of the current proposals.