Senate Reveals Healthcare Reform Bill

Republican leaders in the Senate unveiled a long-awaited healthcare reform bill, called the Better Care Reconciliation Act of 2017, that will roll back the Affordable Care Act (ACA)’s taxes and Medicaid expansion, although at a slower timeline than included in the House of Representatives’ American Health Care Act (AHCA), which was passed on May 4 by a vote of 217-213.

The Senate bill repeals the individual mandate and the employer mandate and seeks to stabilize the insurance market through $15 billion for each year of 2018 and 2019 and $10 billion for each year of 2020 and 2021. The money will be appropriated and provided to the administrator of CMS to “fund arrangements with health insurance issues to address coverage and access disruption and respond to urgent healthcare needs within states.” Insurers will need to submit a notice of intent to participate in order to receive funding

“Republicans believe we have a responsibility to act and we are,” Senate Majority Leader Mitch McConnell (R-Kentucky) said on the Senate floor. “For our constituents, for our states, and for our country. We’ve long called for a better way forward…”

According to McConnell, the Senate bill will stabilize the health insurance markets, it frees Americans from costly and onerous mandates under the ACA, it improves the affordability of health insurance, and preserves access to care by allowing children to stay on their parents' health insurance through age 26 and not allowing states to waive coverage of preexisting conditions. This last point is where the bill differs from the AHCA. The House bill added an amendment that would allow states to opt out of covering preexisting conditions after House Majority Leader Paul Ryan (R-Wisconsin) had to pull the AHCA from the House floor when it became apparent that the most conservative members of the Republican Party were not going to vote for the bill.

In most other ways, the bill is similar to the AHCA that passed the House, but the subsidies are based on age, as they are with the ACA, instead of income, as they are in the House bill. The Senate’s bill also enacts large cuts to Medicaid, but more slowly phases out the expansion over the course of 4 years starting in 2020. Similar to the House bill, the Senate’s bill would convert Medicaid to a block grant program.

“Simply put this bill will result in higher costs, less care, and millions of Americans will lose their health insurance, particularly through Medicaid,” Senate Minority Leader Charles E. Schumer (D-New York), said on the floor of the Senate.

McConnell can only afford to lose 2 Republican votes if he wants the bill to pass. At The Washington Post’s last count, no GOP senators have outright said they will or are likely to vote against the bill, but 11 have concerns and said they are considering voting against it if those concerns are not addressed.

Those who have concerns include some of the most conservative members, who believe the bill doesn’t go far enough—such as Senators Ted Cruz (R-Texas) and Rand Paul (R-Kentucky)—and some of the least conservative members, who are hesitant to rollback so much of the ACA—such as Senators Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska). Also potentially on the fence is Senator Dean Heller (R-Nevada), who is up for reelection in 2018.

The Congressional Budget Office (CBO) will now have just a week to score the Senate bill if the Senate is going to vote before its members go home for the Fourth of July recess. The CBO scored the House bill after it was passed and found that AHCA would save $119 billion but increase the number of uninsured Americans to 23 million over the course of 10 years.

The CBO isn’t the only one with a tight timeline. Many Republican senators are also seeing the bill for the first time, giving them just days to review the bill before a potential vote next week. However, McConnell assured the Senate that there will be enough time.

"There will be ample time to analyze, discuss, and provide thoughts before legislation comes to the floor," he said. At that time, Senate Democrats, who have not helped shape the legislation that would repeal large parts of the ACA, will have the opportunity "to do what is right" by the American people, McConnell said.