The Senate Budget Committee released an updated version of the Senate ACA repeal vehicle today, known as the Better Care Reconciliation Act of 2017. As expected, it includes more money for opioid abuse treatment, increases funding for stabilization of the individual market, and eliminates repeal of certain taxes on high earners. The draft also includes a provision sponsored by Sen. Ted Cruz that permits sale of plans that do not meet the requirements of Qualified Health Plans under the ACA.
This latest version does not include changes to Medicaid reform- something with which Senate moderates had concerns - but reflects the fact that Republicans will not easily give up on this long-sought policy goal.
Taking into account all amendments to date, below is a summary of the major provisions in a handy clip and save chart:
Downloadable copy here.
Shortly before Senate leadership released the latest version of their bill, Senators Lindsey Graham and Bill Cassidy announced a Plan B of sorts. There appears to be no legislative text at this point. Cassidy's office did provide the following bullet points:
- Federal dollars currently spent on Obamacare health insurance – an estimated $110 billion in 2016—would be annually granted to the states to allow for local innovation and flexibility for health care service
- The individual mandate and employer mandate instituted under Obamacare would be repealed under Senate reconciliation rules which only require 50 votes.
- The requirements covering pre-existing conditions would be maintained.
- The Obamacare medical device tax would be repealed
- .Federal Medicaid funding to the states will continue to grow in a sustainable manner, adjusted for inflation. Provides additional flexibility to the states to ensure health care dollars are spent in a manner providing the most effective and efficient coverage based on their health care needs and populations
- Federal funds would be restricted to health care spending only. These funds could be distributed by the states in the forms of tax credits, reinsurance, health savings account premiums, and other means as the individual states see fit to meet their health care needs.
What the Senators are proposing is one big giant block grant program with a few conditions like maintaining pre-existing conditions. We suspect the strategy is not so much to offer an alternative to leadership's bill but to provide an another option for the current back-up plan advocated by the White House - straight repeal a la 2015 bill.
As of this writing - ask us again in a few hours and things may well have changed - there will be a vote next week. Reportedly there will be a CBO score on Monday. Do not look for anything too different from previous iterations. The CBO relies heavily - even if the American people do not - on the power of the individual mandate to convince the uninsured to become insured. Majority Leader McConnell has two hard "nays" - Sen. Susan Collins and Sen. Rand Paul. We doubt he will lose any more on the preliminary vote to proceed - which is when the horse trading will get really interesting.The outcome is far from certain but our money is still on Mitch McConnell to get something done.
Call with questions. We are hear 24/7/365 just like the government, except without all that power.
Emily Evans
Managing Director
Health Policy
@HedgeyeEevans
