The drama surrounding the Senate's health care bill continues to mount, and a vote on a motion to proceed is expected to happen as early as Tuesday, July 25. There are a great many unknowns, though, including which version of the health care reform bill will be considered. To date, there have been at least four possibilities floated - the House-passed American Health Care Act (AHCA), the Senate's Better Care Reconciliation Act (BCRA), a straight repeal called the Obamacare Repeal Reconciliation Act (ORRA), or an updated BCRA that includes the "Cruz amendment" that would allow insurers to sell scaled-down plans lacking essential health benefits. (See also WICs article, "Dizzying Week in Congress Leaves Future of Health Care Bill Even More Unclear," July 20, 2017.) ANCOR has developed a quick reference guide comparing the three main proposals.
With the various bill versions have come various Congressional Budget Office (CBO) scores. Most recent estimates from CBO include loss of health insurance coverage by 17 million people and cuts of $756 billion from the Medicaid program. These numbers are slightly lower than some previous estimates had been, but still represent a gutting of Medicaid by shifting costs to states that cannot possibly make them up. One idea that has been floated to partially mitigate those cuts is the addition of $200 billion in Medicaid "wraparound" funding that would allow states to provide subsidies for low income individuals to purchase private insurance. Budget analysts are quick to point out that adding $200 billion does not replace taking out $756 billion from a program.
The CBO also released an estimate on a straight ACA repeal, which is the ORRA. That bill would result in an additional 32 million people to lose insurance coverage and end the Medicaid expansion in 2020, but would not include the structural changes to Medicaid that other plans have included. At this time, there is no replacement plan proposed to accompany a straight repeal.
Meanwhile, the Senate parliamentarian has made determinations on several pieces of the BCRA and whether they run afoul of the "Byrd rule", which requires that bills in the Senate that come through the budget reconcilation process must not contain "extraneous" provisions. In the parliamentarian report, items that run afoul of the Byrd rule include restrictions on tax credits being used for insurance plans that cover abortion, the defunding of Planned Parenthood, and sunsetting essential health benefit requirements in Medicaid alternative benefit plans. Any provision that violates the Byrd rule may not be considered through the reconcilation process, but would have to be deliberated on in regular order, which means a higher bar of 60 votes would be required to pass. Some provisions in the current BCRA that the parliamentarian has ruled do not violate the Byrd rule are Medicaid work requirements, establishing a state stability and innovation fund, and repealing cost-sharing subsidies.
Senate Majority Leader Mitch McConnell (R-KY) has said that the Senate will take up one of these plans early this week, though at this time it is unclear whether he has the 50 votes required to advance to floor debate. Senator John McCain (R-AZ) was diagnosed with brain cancer just over a week ago, and it is uncertain whether he will be available for a vote this week, complicating the math for Senate Republicans. Certain Senators who had been in the "no" column on a motion to proceed have wavered in their positions, making their opposition less certain. Notably, Rand Paul (R-KY) and Shelley Moore Capito (R-WV) have made statements indicating that there are circumstances under which they would vote to advance a bill to the floor for consideration. If the motion to proceed passes, the next step is a floor debate, including a "vote-o-rama" where Senators from both parties can offer numerous amendments. At the close of the floor debate, the Senate Leader can move to a vote on the bill as a whole.
ANCOR has deep concerns over all of the versions of the bills that have come up, and will continue to push out action alerts until the vote. (Check your inbox for the alert we sent out this morning!) It is critical that constituents continue to flood their Senators' offices with phone calls and emails urging them to vote no on any version of the Senate health care bill.