What's Happening with that Senate ACA Repeal Bill?

Update: Senate Majority Leader Mitch McConnell announced that Senate Republicans on Tuesday that he would be delaying a vote on the Better Care Reconciliation Act until after the weeklong July 4 recess.

The delay comes after several Senate Republicans expressed concern over the contents of the bill, with some saying that it didn't do enough to repeal Obamacare and others saying cuts to Medicaid would be too severe.

The delayed vote doesn't mean the bill is dead, however. The vote on the House's ACA repeal bill, the American Health Care Act, was also originally postponed just before it was scheduled to take place, but a revised version did end up being passed. Repealing the Affordable Care Act remains a priority for the GOP, and those watching should expect to see a vote at some point, although exactly how soon that vote will be and what revisions might need to be made to the BCRA to get 50 Senators on board remains to be seen.

CBO weighs in on Senate Republicans’ ACA repeal bill

Last Thursday, Senate Republicans released their proposed plan to repeal and replace the Affordable Care Act (ACA). The bill, titled the Better Care Reconciliation Act (BCRA), comes almost two months after the House passed its version of an ACA repeal bill, the American Health Care Act (AHCA).

Yesterday, the Congressional Budget Office (CBO) weighed in on the Senate ACA repeal bill. According to the CBO, an estimated 22 million more people would be uninsured by 2026 under the BCRA, compared to the current law. The BCRA’s CBO score when it comes to the number of uninsured is marginally better than AHCA’s, which the office estimated would result in 23 million more people losing coverage over the next ten years.

The CBO also estimates that both plans would result in significant reductions to the federal deficit in that same time - $321 billion in the case of the BCRA, and $119 billion in the case of the AHCA.

Comparing the two ACA repeal bills

What do the BCRA and AHCA have in common?

• Although both the BCRA and the AHCA are touted as ACA repeal bills, they are in fact both budget reconciliation bills, which means they can only address provisions of the ACA that directly relate to budgetary issues (i.e. taxation and federal spending).
• Both bills would reduce the penalties imposed under the employer and individual mandates to zero.
• Both bills would phase out federal funds for states that participated in the ACA’s Medicaid expansion program.
• Under both plans, the majority of the ACA remains unaffected, including key provisions like the one that allows individuals under the age of 26 to get insurance through a parent’s plan, as well as requirements to cover pre-existing conditions.
• Both proposals would repeal federal subsidies to qualified low-income individuals who purchase coverage through the Exchanges, effective in 2020.
• Both the AHCA and the BCRA replace the ACA’s individual mandate with penalties meant to punish individuals who don’t maintain continuous coverage, but the way the two bills would achieve this differs. (See below for more explanation.)
• Both plans would delay the Cadillac tax from taking effect until 2026.
• To the displeasure of some employers, neither proposal would repeal the ACA’s reporting requirements as they relate to the employer and individual mandates.

How does the Senate bill differ from the House bill?

There are, of course, a few key differences between the two proposals:

• The House's ACA repeal bill included options for states to obtain limited waivers from the ACA’s essential health benefits (EHB) requirements and community rating rules. The Senate's ACA repeal bill would eliminate the state waiver option, and instead enhance the ACA’s existing Section 1332 State Innovation Waiver program.
• Although the original draft of the BCRA didn’t include a provision replacing the ACA’s individual mandate, a new draft released on Monday did address the issue. The AHCA proposed to incentivize healthy people to maintain coverage by imposing a 30 percent late-enrollment premium surcharge for individuals who fail to maintain continuous health care coverage. The updated Senate proposal, on the other hand, would prevent individuals who go without coverage for more than 63 days from obtaining coverage for the next six months, essentially locking them out of coverage.

For a more detailed visual overview of the how the two proposals compare to each other, as well as to the ACA, check out this chart from NPR: Who Wins, Who Loses With Senate Health Care Bill.

What happens next?

Does the GOP have the votes it needs to pass its ACA repeal bill?

Senate Republican leaders are pushing for a vote to happen before the upcoming July 4 weekend, which means we could get a clearer picture on the future of health care reform any day now. But even if a vote does happen this week, it’s unclear whether the GOP has the votes it needs to pass the bill.

Republicans can only afford to lose two votes and still pass the bill, and, as of this post, five senators had come out in opposition of the bill in its current form, with several other citing concerns. To meet their goal of holding a vote before the end of the week and avoid the stall House Republicans encountered with their first attempt to pass a bill, proponents of the bill may have to do some serious negotiating to get enough senators on board.

How close are we to a new law?

Even if the Senate does pass the BCRA, its differences from the AHCA means that the BCRA will have to be approved by the House before it can make its way to President Trump’s desk.