Senate Majority Leader Mitch McConnell announced today that the Senate would be staying in Washington an extra couple of weeks to deconstruct the beaver dam erected by the health care debate and drain the pond of work that has accumulated behind it.
While the delay in the start of the August break is meant as a response (or a punishment, depending on your viewpoint) to the slow pace of legislative activity overall than it is a way to provide more breathing room for ACA repeal, the result is, well, more breathing room for ACA repeal.
This afternoon, McConnell did reiterate the schedule he put forth this morning; new ACA draft repeal bill will be released Thursday, CBO score will be issued Monday and a vote will be held next week.
We have and continue to be in the “something will get passed camp” though we admit our confidence has waned a bit as a result of the incessant and hyperbolic press coverage of the issue. Our probability for passage is about 54-46, down from 60-40 before the July 4 break but up from the 50-50 last week.
Our probability is based on the options available and their implications.
When it comes to major legislation there are only two options: “aye” and “nay.” Currently the bill the Senate would consider includes the Better Care Reconciliation Act released a few weeks ago with the following modifications:
- Retain some of the taxes such as the net investment tax and the additional Medicare tax (on high income earners), in order to avoid appearance of helping the “rich” while cutting Medicaid. These taxes could be repealed as part of tax reform later in the year.
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Delay the phase out of the Medicaid expansion further and abandon use of CPI-U in out years in favor of retaining CPI-U Medical Care as the inflator.
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Add funding for opioid treatment
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Add Cruz amendment that would allow insurers to sell a less regulated plan if they also sell an ACA compliant plan.
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Add more stabilization and/or subsidy money to offset some adverse selection issues that result from the Cruz amendment.
As we see it, the implications for voting “aye” and “nay” break down as follows:
Projections on insurance coverage notwithstanding, the cold political calculus of the vote does not argue well for a “nay.” One of the more significant of those political consequences is the increased likelihood that a partial repeal vote will be brought forward.
Recall that both chambers passed partial repeal via the reconciliation procedure in late 2015 that was ultimately vetoed by President Obama. That bill contained none of the stabilization and amelioration provisions in the AHCA/BRCA.
If that 2015 bill were presented today, Republicans in both houses would be forced to vote “aye” or explain why they changed their minds. While consistency and hypocrisy avoidance are not hallmarks of any complex political system, that result would be awkward at best.
At this point, the Trump administration has suggested straight repeal as an alternative while a few Senators think it is a non-starter – which it is…until it isn’t.
Finally, we will take this opportunity to remind you that the Trump administration does not necessarily need the AHCA/BRCA to reform the American health care system. Today, HHS approved a Section 1332 waiver for Alaska to stabilize their individual insurance market with $323 million over four years. More 1332 waivers and Section 1115 waivers are pending.
We will be talking more about the ACA on our 3Q Health Care Themes call on July 17th @ 1pm. Hit for access. In the meantime, call with questions. We are here all day every day.
Emily Evans
Managing Director
Health Policy
@HedgeyeEEvans
