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Capitol Hill Update: Affordable Care Act Repeal on the Ropes?

UPDATE: Shortly after this post went live, Senate Majority Leader Mitch McConnell announced that he would be delaying the vote on the Better Care Reconciliation Act until after the Fourth of July recess.  Stay tuned for further updates and analysis from the team at ML Strategies!

The Senate bill to repeal the Affordable Care Act is currently being poured over by Senate Republicans and their staff, but the early prognosis for a vote this week is not good. Senate leadership had set a goal of voting on this legislation – known as the Better Care Reconciliation Act (BCRA) – before the Fourth of July recess, which means by this Friday. However, calls for more time to review the bill as well as concerns over certain key provisions – like those touching Medicaid – may stall Senate progress at a critical moment for health care repeal efforts. Here’s where things stand:

Last 24 Hours:

On Monday, the Congressional Budget Office (CBO) released its analysis of the BCRA projecting 22 million people would be uninsured over the next decade, including 15 million Medicaid beneficiaries. However, the Senate bill would save $321 billion over a decade -- a much higher threshold of savings than the House's $119 billion. The CBO score also indicates that premiums will drop in the exchange marketplace, but there will likely be higher out-of-pocket costs and less generous coverage packages.

Since the release of the score, nearly a dozen Republican members expressed concern over the bill, and five members – Sens. Susan Collins (ME), Rand Paul (KY), Dean Heller (NV), Ron Johnson (WI), and Mike Lee (UT) – publicly said they would oppose a “motion to proceed” vote required to bring the bill up for consideration. These five members come from different corners of the Republican conference, and all present different reasons for their opposition. In addition to these five, a number of members have expressed concerns but did not go as far to say they would not support the bill, leaving open the possibility for changes to the legislation.

Next 24 Hours:

As noted above, the CBO report also projects that the BCRA would reduce the federal deficit by $321 billion over the next decade, or $202 billion more than the estimated net savings from the House-passed American Health Care Act. That gives Senate Majority Leader Mitch McConnell some room to amend the BCRA with additional funding.   Two potential areas to watch are additional funding for opioid treatment efforts and a change to tie the annual increase, beginning in 2025, for the Medicaid per capita cap to the consumer price index for medical care (CPI-M) rather than to tie to the consumer price index for all urban consumers (CPI-U).  The latter change would lead to greater increases to the per capita cap each year.  McConnell will need to find the right balance to secure 50 votes and cannot be discounted despite the numbers.

Senate Majority Whip John Cornyn (TX) said the Senate still plans to vote this week. The Administration is stepping in to help push a vote across the finish line with President Trump meeting with Sen. Rand Paul (KY) today at the White House. We should have a better idea of the likelihood of such a vote later this afternoon.

Please stay tuned for future updates.

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