ACA Repeal and Replace Update

Recently, the Senate GOP leadership released a “discussion draft” of legislation to repeal and replace the Patient Protection and Affordable Care Act (ACA). The bill follows many of the same general pathways toward “repeal and replace” of the ACA as were included in the House bill (American Health Care Act), however, there are some significant differences.

The Senate leadership proposal, called the Better Care Reconciliation Act of 2017 (BCRA):

  • Would repeal the individual and employer mandate-penalties included in the ACA.
  • Would provide a longer timeline for phasing out the Affordable Care Act's Medicaid expansion (than the House bill).
  • Would not penalize consumers for having a break in coverage.
  • Would link premium support to income, age and geography, rather than just age.
  • Would tie that assistance to "bronze" plans.
  • Would make health insurers be prohibited from denying coverage or charging higher rates for individuals with pre-existing conditions.

A more detailed analysis is available.

Senate democrats remain highly critical of the GOP efforts to repeal and replace the ACA and no democrats are expected to lend their support to either the American Health Care Act (AHCA) or the Better Care Reconciliation Act (BCRA). This means that the Senate will have to pass the bill exclusively with GOP support. With a 52 – 48 majority, the Senate republican leadership can only afford to lose two GOP Senators if they have any hope of passing this bill. While several GOP Senators expressed concerns about particular aspects of the bill, many – both conservatives and moderates – seemed intent on moving in a direction that would get 50 GOP Senators to “yes.”

As we saw with the AHCA, there will be changes made to the BCRA before it is brought before the Senate for a vote. Over the next several days, the GOP Leadership will meet individually with Senators to hear their concerns and to see what can be done to get them to “yes.” Individual Senators have already staked out areas where they would like to see changes or modifications. The challenge facing the Senate leadership is accommodating changes requested by one senator (or group of senators) in such a way that the change does not alienate another senator.

Although the Senate GOP leadership has expressed a desire to hold a vote on the BCRA prior to the July 4 recess, that timetable may be overly ambitious. It is not clear whether all of the negotiations necessary to secure the 50 votes needed to pass the bill can be completed by July 1. A more likely scenario is that the vote is held over until the week of July 10 when senators return to Washington.

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