- The Senate parliamentarian has ruled that some portions of the Republican bill to replace the Affordable Care Act (ACA) cannot be passed through the budget reconciliation process that requires only a simple majority for approval. Those provisions include removing essential health benefits for state Medicaid plans, imposing a six-month lockout against people who have not maintained continuous coverage and the defunding of Planned Parenthood.
- The parliamentarian is still reviewing some key parts of the bill, including waivers that allow states to avoid essential health benefits and avoid requirements that protect people with pre-existing conditions. The section that allows insurers to charge older people five times more than younger people is also still under review.
- Senate Republicans said they may attempt to rework the bill so that is passes the Byrd Rule requirement that all measures pertain directly to the federal budget. Senate Majority Leader Mitch McConnell has said there will be a healthcare vote this week, but he hasn't said whether it will be the Senate bill, a repeal-only bill or something else, The Los Angeles Times reported.
The ruling is yet another blow for McConnell and Republican leaders intent on at least putting a vote to repeal the ACA on the record. President Donald Trump has lately stepped up the pressure for members of the GOP to vote for repeal or face the political consequences.
Meanwhile, the healthcare industry must wait without knowing the future of cost-sharing reduction payments for insurers, potential major cuts to the Medicaid program and hiring impacts. The American Medical Association on Friday sent a letter to Senate leaders urging them to stop attempts to repeal the ACA entirely, because recent “revisions do not correct core elements that will lead to millions of Americans losing health insurance coverage with a resulting decline in both health status and outcomes.”
A successful vote will be very hard to wrangle, though. Hard-right conservatives were already frustrated with the Senate bill, saying it did not go far enough in repealing the ACA. The ruling against the provision defunding Planned Parenthood will make it even harder to sway them.
Enough senators had already come out against the Senate bill to sink it. The more moderate wing of the party is also opposing the repeal-only bill, which the Congressional Budget Office estimates would result in 32 million people losing coverage in the next 10 years. As many as 17 million would lose coverage by next year.
Opponents of repeal aren't yet ready to declare victory, though. Moderate Republicans will be getting a lot of pressure — and potentially targeted provisions in the bill that help their states. Also, the bill that passed the House in May seemed similarly doomed until some last-minute maneuvering.