In recent weeks, Senate Republican leaders held a series of private meetings to draft a bill they hope will repeal and replace the Affordable Care Act (ACA) through the budget reconciliation process, which allows Congress to repeal and replace key components of the ACA legislation with a simple majority vote (and with no opportunity for filibuster) as long as the proposed changes directly impact the federal budget. On June 22, 2017, after enduring criticism from both Democrats and Republicans for writing the bill in secret, Senate Majority Leader Mitch McConnell revealed a draft for discussion, titled the Better Care Reconciliation Act (BCRA). On June 26, Senate Republicans released an updated version with minor revisions.
The Senate’s draft bill contains many of the same provisions as the House’s proposed American Health Care Act (AHCA), but there are some notable differences between the two bills.
Like AHCA, the Senate’s proposed legislation would:
- Eliminate the ACA’s Employer and Individual Mandate penalties for 2016 and future tax years
- Not modify or eliminate any ACA employer reporting requirements
- Expand contribution limits and permissible expenses for Health Savings Accounts
- Provide states the potential for exemptions from certain ACA requirements
- Delay the Cadillac Tax until 2026
- Defund Planned Parenthood for one year
Unlike the House’s bill, BCRA would:
- Maintain the healthcare subsidies (advance premium tax credits) introduced under ACA while tightening the eligibility criteria starting in 2020
- Penalize individuals who allow their healthcare coverage to lapse by imposing a six-month waiting period for new coverage rather than by imposing a 30-percent surcharge
- Delay the rollback of ACA’s enhanced Medicaid expansion until 2021
- Significantly revise the future structure of the Medicaid program
CBO Score: Projected Impact of the Better Care Reconciliation Act (BCRA)
On June 26, 2017, the Congressional Budget Office (CBO) released its report scoring the projected impact of the proposed bill. If the Senate bill became law without any amendments, the CBO estimates that BCRA would reduce the federal deficit by $321 billion but would leave 22 million more people without insurance. For reference, the House bill was previously estimated to reduce the deficit by $119 billion and leave 23 million more people without insurance. The BCRA score forecasts a significant savings compared to ACA and the House bill, but it still projects that a considerable number of Americans will be left without access to affordable healthcare coverage.
Now that BCRA has been unveiled to the entire Senate for review and the CBO released its impact score, senators who were previously in the dark are taking time to review the bill. Majority Leader McConnell indicated last week that he intended to bring the bill to the Senate floor for a vote prior to Congress taking a recess for the week of July 4th. However, considering the bill will undergo 20 hours of formal debate and amendments before the Senate takes it to a vote, pushing for a vote by the end of this week left little time for senators to review the bill before deciding if they were ready to proceed in considering and debating it. Sensing that a majority of his fellow senators were not prepared to vote in favor of the bill, the Majority Leader today announced he will delay the vote until after the Senate reconvenes.
Although the bill could pass the Senate upon their return, Democratic and both conservative and moderate Republican senators have expressed significant concerns over the bill in its current state. In an attempt to appease enough members of these groups to garner the 51 votes required to pass the bill, Senate Republicans will likely propose a number of amendments before the bill is taken to a vote. Delaying the vote provides more time to craft and propose amendments that might persuade more senators to vote in favor of the bill, similar to how the House bill was withdrawn without a vote due to lack of support before it was later revised and passed. Even if the bill does pass the Senate after the July 4th recess, it must still be approved by another simple majority vote in the House before it can be signed into law.
As President Trump and the Republican party edge closer to repealing and replacing ACA, a number of hurdles remain. Unless and until a repeal is passed and signed into law, ACA remains in effect, and all employers are encouraged to continue complying with existing regulations.
The discussion draft of the Better Care Reconciliation Act can be found on the official site of the Senate Budget Committee at the following link: Discussion Draft – Senate Republican Health Care Bill.
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