News | Business | July 26, 2017

Senate Opens Debate on Better Care Reconciliation Act

ACC opposes legislation; first full Obamacare repeal-and-replace legislation voted down following opening of debate; multiple versions expected to be unveiled in quick succession

Senate Opens Debate on Better Care Reconciliation Act

July 26, 2017 — The U.S. Senate voted Monday, with a tiebreaking vote from Vice President Mike Pence, to begin debate on the Better Care Reconciliation Act (BCRA), the legislation drafted by Senate Republicans to repeal and replace the Affordable Care Act (ACA). Senate Majority Leader Mitch McConnell immediately called a vote on the first version of the bill, which was defeated 57-43.

Since the 115th Congress began session in January, Republicans in the House and Senate have made repealing the ACA, also known as Obamacare, a top priority. The House passed its version of a repeal-and-replace bill, called the American Health Care Act (AHCA) in April after lengthy debate and the withdrawal of the first version by Speaker Paul Ryan (R-Wis.). Both chambers have seen progress stalled by extensive disagreements between moderates and the most conservative members of the Republican party.

The version of the BCRA defeated on Tuesday was designed to appease the moderate Republican faction by adding back Obamacare taxes removed from prior iterations, including the net investment income tax, the additional Medicare Health Insurance Tax and a tax on high-earning health insurance executives. The bill included an amendment, introduced by Sen. Ted Cruz (R-Texas), that would have allowed insurance providers to sell stripped-down plans that did not comply with ACA requirements as long as they offer at least one policy that does. The final major piece was a $70 billion allotment for states to help consumers with paying out-of-pocket healthcare costs in the form of cost-sharing or health savings accounts.

Intact from the first version of the Senate bill was the gradual rollback of the ACA’s Medicaid expansion. Under McConnell’s vision, Medicaid would be changed from an open-ended entitlement program to a fixed amount of money granted to states based on enrollment or as a block grant. The BCRA would reduce the annual growth rate of those funds beginning in 2020.

With the failure of the full repeal-and-replace legislation, Republican leadership may eventually introduce a “skinny” version that only repeals a few ACA requirements to try to ensure passage. These would include the individual and employer insurance mandates, the medical device tax and the public health fund, according to the Washington Post.

The heathcare debate has been heavily criticized by medical societies and insurance providers because the Republican-led efforts fail to address actual healthcare concerns, may increase healthcare costs and will leave millions of patients currently insured uninsured. 

“In light of new analysis from the Congressional Budget Office (CBO), it is clear that the health reform measures being contemplated in the Senate, whether the Better Care Reconciliation Act or the Obamacare Repeal Reconciliation Act, would result in the loss of insurance coverage for millions of Americans, limiting access to care for those who need it most," said American College of Cardiology President Mary Norine Walsh, M.D., FACC. “The American College of Cardiology opposes both of these approaches to health reform. Instead, we urge Senate leaders and members on both sides of the aisle to work in an open, bipartisan process to advance concepts that align with the ACC’s Principles for Health Reform. These principles prioritize patient access to meaningful insurance coverage and protection for individuals with pre-existing conditions, goals that would advance the outcome we all strive for: a healthcare system that strengthens and secures the highest quality care for all Americans.”

Read about the "Affordable Care Act "Skinny Repeal" Defeated in Senate," news from July 28, 2017.

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