On July 13, 2017, the Senate released its revised Affordable Care Act (ACA) repeal and replace bill, the Better Care Reconciliation Act of 2017 (BCRA), along with updated summaries (Titles I and II, and Title III) of the legislation. The Senate had planned to take up BCRA this week, following the expected release today of the Congressional Budget Office (CBO) analysis of the bill’s impact on coverage and the Federal deficit. However, Senate Majority Leader Mitch McConnell (R-KY) announced over the weekend that action on BCRA would be postponed until Senator John McCain (R-AZ), has recovered from surgery and returned to Washington. The CBO score is not expected to be released today.

Under the budget reconciliation process, Senator McConnell can only lose the support of two Republican Senators and still have the 50 votes necessary for BCRA to pass, with Vice President Mike Pence casting the tie-breaking vote. Senators Rand Paul (R-KY) and Susan Collins (R-ME) had earlier signaled their opposition to the current draft bill and their intention to object to a motion to proceed to debate the legislation. Without Senator McCain present, there would not be the necessary 50 votes to begin debate on BCRA.

Major revisions to BCRA, since its initial release on June 22, include the following:

• An amendment authored by Senator Ted Cruz (R-TX), effective in 2020, to allow insurers to sell plans that do not meet ACA requirements, provided they sell plans that do;

• An additional $45 billion from 2018-2026 in funding for substance abuse and recovery treatment;
• Additional funding to stabilize the individual market and help low-income individuals purchase health insurance;
• A change to allow Health Savings Account (HSA) funds to be used to pay for premiums of high-deductible health plans as well as medical expense of children under age 27;
• Retaining instead of repealing certain ACA taxes:  net investment income tax, the Medicare tax surcharge for taxpayers earning more than $200,000 a year, and the  limit on deduction for executive compensation; and
• Reducing State regulatory requirements for association health plans.

On July 13, 2017, Senator Lindsey Graham (R-SC) announced that he and Senator Bill Cassidy (R-LA) had drafted an alternate approach to ACA repeal and replace, directing Federal funding provided under the ACA to the States to use. Their bill would retain all of the ACA taxes, except the medical device tax. Senator Graham offered that his legislation might attract bipartisan support should the current repeal and replace bill stall.

Vice President Pence asked for State governors to support the Senate bill, in a speech before the National Governors Association summer meeting. Vice President Pence noted that “as Medicaid grows there's less and less money for schools, for roads and for public safety….The Senate health care bill restores Medicaid to its original purpose.” HHS Secretary Tom Price and CMS Administrator Seema Verma briefed the governors on the Senate bill and outlined their approach to providing flexibility to the States.

Last week, Senator McConnell announced that, instead of adjourning on July 28 for its August recess, the Senate would remain in Washington for the first two weeks of its planned August recess to work on health care, tax reform, and other matters. The House Republican Leadership indicated the House has no plans to be in session for the August recess, but that the House would return if the Senate passes its ACA repeal and replace bill.

For a description of the earlier version of BCRA, please see the June 26, 2017 Health Headlines article here.