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Updated 7/18: Senate Healthcare Reform Stalls Out


UPDATE 7/18: A revised edition of BCRA wasn't enough to garner the votes needed to pass the Senate healthcare reform measure ... or even bring it to a vote. Although a number of senators previously pledged not to consider 'repeal' without a 'replace' strategy in hand, it now appears the U.S. Senate leadership is moving toward such a vote with a three-year rollback of the Affordable Care Act to give Congress time to create a replacement plan. Considering earlier opposition to this path, it isn't clear whether the votes will be there to repeal without immediate replacement. If that fails, the next step would be to try to craft bipartisan legislation.

UPDATE: 11 am 7/13: Multiple Washington, D.C. sources have reported Sen. Majority Leader Mitch McConnell's revised version of the Better Care Reconciliation Act (BCRA) includes some of the language in the Cruz/Lee amendment that allows insurers to sell scaled-down insurance plans that do not meet ACA essential benefits guidelines, as long as those insurers also have plans that do meet ACA-established criteria. The concern from moderates is that such a move would encourage healthy people to opt for the lesser plans, and in turn, raise premiums for those with preexisting conditions on ACA plans. In an attempt to address those concerns, the new BCRA version is said to include more money to help offset premiums hikes.

The bill is expected to add another $70 billion in premium support, $45 billion to address opioid addiction, and leave some of the taxes in place for the nation's wealthiest citizens. However, no changes have reportedly been made to the Medicaid portion of the bill, which is worrisome to a number of moderates. McConnell can only afford to lose two senators if the legislation is to pass.

UPDATE 1:15 pm 6/27: Senate vote delayed until after July 4 recess per Senate Majority Leader Mitch McConnell.

UPDATE 4:00 PM 6/26: Scoring is out from the Congressional Budget Office on the Senate healthcare reform plan. The nonpartisan CBO has estimated 22 million Americans will lose their health insurance by 2026 after Senate measures are fully implemented. That number is about 1 million less than the House AHCA version. Additionally, the CBO also said premiums should begin to decline in 2026 after initially rising and that the Senate plan would decrease federal spending by $321 billion by 2026, which is significantly more than the House version's savings of $119 billion.

UPDATE 6/26: In an effort to close the loophole left in the Senate bill by not including the individual mandate but preserving coverage for those with pre-existing conditions, the Senate bill has been revised ahead of CBO scoring to include a waiting period for those who let their coverage lapse. The move addresses a concern that individuals would opt to not carry insurance until they were diagnosed with a condition or disease and would only then purchase coverage from insurers who were not allowed to turn them down. Starting in 2019, the revision calls for a 6-month waiting period for those who allow their coverage to lapse for 63 days or longer in the prior year when trying to purchase during open enrollment or a qualifying event.

June 22, 2017 ... After weeks of behind-closed-doors meetings, the much-awaited Senate version of healthcare reform was released as a discussion draft today. Senate Majority Leader Mitch McConnell (R-KY) and a select number of colleagues have spent weeks working on their version of ACA repeal and replace.

Early analysis shows the Senate version of healthcare reform ("The Better Care Reconciliation Act of 2017) giveth and taketh away. It appears to be more generous than the House counterpart in terms of offering assistance to purchase healthcare insurance but is more stringent than the House on curtailing federal Medicaid spending growth.

The 142-page bill released today is being seen for the first time by many Republicans, as well as Democrats. McConnell has stated his goal to bring the measure to a vote before the July 4th holiday, but a number of senators on both sides of the aisle have indicated they want ample time to digest the contents of the bill and get feedback from constituents. Unlike their colleagues in the House, the Senate won't take a vote won't before the Congressional Budget Office scores the measure. To prevent the possibility of a Democratic filibuster, the bill has to meet budget reconciliation rules.

With no Democrats expected to vote for the bill, McConnell must rally support from almost all Republican senators - a tall order considering the deep idealogical divides regarding healthcare within the membership of each party. If the bill passes, then it must return to the House for a vote where additional opposition to various components of the Senate version can be expected.

Some of the provisions in the Senate discussion draft include:

Tax credits continue to help purchase insurance for Americans with incomes up to 350% of the federal poverty level (after 2020 and up to 400% until then as is currently the case under ACA). However, federal subsidies to insurers to help lower income citizens with deductibles and co-pays would stop after 2019.

Slow roll back of the significantly higher federal match rate that was part of the ACA Medicaid expansion program adopted by 31 states, which could prompt some of those states to once again shrink rolls. However, the Senate bill disallows states to opt out of key protections for those with preexisting conditions, which is viewed as a win for millions of consumers.

The bill allows for funding of a federal reinsurance program to stabilize the individual insurance market on a temporary basis.

Most ACA taxes would be rolled back, and the bill eliminates the individual mandate to buy coverage.

The full text of the discussion draft is available here.

Reactions to the Senate bill are here.


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ACA, AHCA, BCRA, Better Care Reconciliation Act, Healthcare Reform, Senate Healthcare bill
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