By Harris Meyer | June
22, 2017
Senate Republicans have released a "discussion draft" of their bill to repeal and
replace the Affordable Care Act that would sharply curtail the law's financial
assistance to lower- and middle-income people to obtain affordable healthcare
coverage.
The Better Care Reconciliation Act of 2017, written behind closed doors by Senate Majority Leader Mitch McConnell and his staff, does offer somewhat more generous assistance than the House Republican repeal bill passed last month. But it ultimately would clamp down more tightly than the House bill on federal Medicaid spending growth, potentially forcing states to more sharply reduce eligibility, benefits, and payments to providers.
McConnell hopes to bring the 142-page bill to a vote on the Senate floor next week, shortly after the Congressional Budget Office issues its estimate of the bill's cost and coverage impact. Prospects for passage are dicey, with both moderate and conservative Senate Republicans expressing doubts about its provisions and a desire for more time to study it. If the Senate passes it, it then would have to go back to the House for approval.
Under the Senate bill, the growth of federal Medicaid payments to the states would be capped for most beneficiaries at the medical component of the consumer price index starting in 2020, then would be limited to the much lower CPI rate starting in 2025.
The ACA's enhanced federal payments for Medicaid expansion would be phased out over several years, likely prompting most of the 31 states that have extended Medicaid to low-income adults to terminate that coverage.
Tax credits to help people buy insurance in the individual market would be offered to those with incomes up to 350% of the federal poverty level, below the ACA's current limit of 400% of poverty.
The bill would fund a temporary federal reinsurance program to stabilize the individual insurance market. After that, states would have to implement their own reinsurance programs, with federal assistance through 2026.
Federal payments to insurers for the ACA's cost-sharing reductions for lower-income exchange plan enrollees would be funded through 2019, after which those subsidies to help people with deductibles and copayments would end.
The bill would repeal almost all the ACA taxes that pay for the law's coverage expansions and benefit enhancements. It remains to be seen whether the CBO will score the bill as producing enough federal budget savings to qualify it for passage under Senate budget reconciliation rules that would prevent Democrats from filibustering the bill.
McConnell has to win support from at least 50 of the 52 Senate Republicans to pass the bill, since no Democrats are expected to vote for it.
Moderate GOP senators such as Susan Collins of Maine and Dean Heller of Nevada will be closing watching to see how the Senate bill affects the projected number of uninsured Americans. The CBO projected last month that the House bill would lead to an increase of 23 million in the number of uninsured.
Healthcare industry group and patient advocates have blasted the House bill for increasing the number of uninsured, and they likely will criticize the Senate bill if the CBO scores it as having a similar effect.
Story developing...
The Better Care Reconciliation Act of 2017, written behind closed doors by Senate Majority Leader Mitch McConnell and his staff, does offer somewhat more generous assistance than the House Republican repeal bill passed last month. But it ultimately would clamp down more tightly than the House bill on federal Medicaid spending growth, potentially forcing states to more sharply reduce eligibility, benefits, and payments to providers.
McConnell hopes to bring the 142-page bill to a vote on the Senate floor next week, shortly after the Congressional Budget Office issues its estimate of the bill's cost and coverage impact. Prospects for passage are dicey, with both moderate and conservative Senate Republicans expressing doubts about its provisions and a desire for more time to study it. If the Senate passes it, it then would have to go back to the House for approval.
Under the Senate bill, the growth of federal Medicaid payments to the states would be capped for most beneficiaries at the medical component of the consumer price index starting in 2020, then would be limited to the much lower CPI rate starting in 2025.
The ACA's enhanced federal payments for Medicaid expansion would be phased out over several years, likely prompting most of the 31 states that have extended Medicaid to low-income adults to terminate that coverage.
Tax credits to help people buy insurance in the individual market would be offered to those with incomes up to 350% of the federal poverty level, below the ACA's current limit of 400% of poverty.
The bill would fund a temporary federal reinsurance program to stabilize the individual insurance market. After that, states would have to implement their own reinsurance programs, with federal assistance through 2026.
Federal payments to insurers for the ACA's cost-sharing reductions for lower-income exchange plan enrollees would be funded through 2019, after which those subsidies to help people with deductibles and copayments would end.
The bill would repeal almost all the ACA taxes that pay for the law's coverage expansions and benefit enhancements. It remains to be seen whether the CBO will score the bill as producing enough federal budget savings to qualify it for passage under Senate budget reconciliation rules that would prevent Democrats from filibustering the bill.
McConnell has to win support from at least 50 of the 52 Senate Republicans to pass the bill, since no Democrats are expected to vote for it.
Moderate GOP senators such as Susan Collins of Maine and Dean Heller of Nevada will be closing watching to see how the Senate bill affects the projected number of uninsured Americans. The CBO projected last month that the House bill would lead to an increase of 23 million in the number of uninsured.
Healthcare industry group and patient advocates have blasted the House bill for increasing the number of uninsured, and they likely will criticize the Senate bill if the CBO scores it as having a similar effect.
Story developing...
Harris Meyer is a senior reporter providing news
and analysis on a broad range of healthcare topics. He served as managing
editor of Modern Healthcare from 2013 to 2015. His more than three decades of
journalism experience includes freelance reporting for Health Affairs, Kaiser
Health News and other publications; law editor at the Daily Business Review in
Miami; staff writer at the New Times alternative weekly in Fort Lauderdale, Fla.;
senior writer at Hospitals & Health Networks; national correspondent at
American Medical News; and health unit researcher at WMAQ-TV News in Chicago. A
graduate of Northwestern University, Meyer won the 2000 Gerald Loeb Award for
Distinguished Business and Financial Journalism
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