On June 27, 2017, Senate Republican leaders postponed a planned vote on the motion to proceed to debate on the Better Care Reconciliation Act of 2017 (BCRA), legislation to repeal and replace the Affordable Care Act, until after Congress’s July 4 recess week. A day earlier, the Congressional Budget Office (CBO) released its score for BCRA. According to the CBO, BCRA would result in 22 million more Americans uninsured by 2026 as compared to current law, would decrease Medicaid spending by $772 billion from 2017-2026, and would reduce the Federal deficit by $321 billion from 2017-2026.
By way of comparison, CBO projected that the House-passed American Health Care Act of 2017 would result in 23 million more uninsured by 2026, would decrease Medicaid spending by $834 billion, and would reduce the Federal deficit by $119 billion over the 2017-2026 time period. At the request of Senate Democrats, who noted that some of the more stringent spending limits occur beyond the ten-year time period that CBO typically analyzes, CBO provided an additional analysis projecting the longer term implications of the legislation. CBO find that Medicaid spending under BCRA as compared with current projections would be 26 percent lower in 2026, rising to 35 percent lower by 2036.
Under the rules of budget reconciliation, Senate Majority Leader Mitch McConnell (R-KY) can only lose the support of two Republican senators and still have the 50 votes necessary—with Vice President Pence casting the tie-breaking vote—for BCRA to pass the Senate. Negotiations have continued in an effort to find agreement on health care reform legislation that could garner 50 votes.
Senate Republicans had agreed to add $45 billion to address the opioid crisis. Governor John Kasich (R-OH), who represents a State that expanded Medicaid, responded to this addition that “it’s like spitting in the ocean. It’s not enough.”
Several additional proposals under discussion are expected to be sent to the CBO to be analyzed over the recess. These include maintaining the ACA net investment income tax to assist lower-income earners afford insurance, and expanding pre-tax health savings accounts so that they could be used to pay insurance premiums. Another proposal advocated by Senators Ted Cruz (R-TX) and Mike Lee (R-UT) would create two health insurance markets—one for individuals with preexisting conditions and providing essential health benefits, and one without.
Senator Rand Paul (R-KY) has cautioned that Senate Republicans remain “at an impasse.” He further noted: “The bill is just being lit up like a Christmas tree full of billion-dollar ornaments, and it’s not repeal.” President Trump, along with Senators Paul and Ben Sasse (R-NE), have advocated a two-step process: repeal first, then work on a replacement. Senator Sasse urged President Trump to call on the Senate, if it cannot reach an agreement on health care legislation by the time Congress returns on Monday, July 10, to repeal first and work through the August recess to pass a replacement health care plan. According to Politico, Senator David Perdue (R-GA) joined other Senators in sending a letter to McConnell, urging Congress to scale back or cancel its August recess to work on health care, a tax overhaul, and other issues.
