- Senate Majority Leader Mitch McConnell said last week if the Better Care Reconciliation Act (BCRA) doesn’t get approved, he will try to pass legislation to shore up the individual insurance market, The Washington Post reported.
- Meanwhile, Sen. Ted Cruz (R-Texas) said the alternative should be a clean repeal of the Affordable Care Act (ACA), even if there is no immediate replacement, according to the Post. This puts him in line with President Donald Trump, who has tweeted a similar stance.
- The already unpopular BCRA seems more unlikely by the day. According to The New York Times, 11 GOP senators have said they won’t support the bill in its current form, but it's often for opposing reasons. Appeasing enough Republican senators to vote for the bill without turning away others would be difficult.
McConnell has been adamant that the bill to replace the ACA will get a vote soon, but his first deadline passed without action and another is quickly approaching. His recent comments, along with those of other lawmakers, indicate Republicans are looking for a Plan B.
McConnell did not elaborate on how exactly he would act to improve the individual market stability, but it would likely involve a commitment to paying insurers cost-sharing reduction (CSR) funds. And GOP statements about the market imploding are, at best, as exaggeration. A recent CBO report states the markets would be mostly stable with no action taken. While several large payers have pulled out of the ACA exchanges for next year, many are pledging to stay. Those that are leaving have said the lack of assurance on CSR payments are the main factor.
Industry groups have remained adamantly opposed to the BCRA, which would decrease patient volumes and increase uncompensated care costs.
As lawmakers went home for the July 4 holiday break, several reported hearing from constituents were upset the law could mean 15 million people losing coverage just next year. Voters who have relied on Medicaid — including people with disabilities, parents and older people — have said the suggested cuts to the program of more than $750 billion (26%) are unacceptable.
On the other hand, the party as a whole is eager to take action against the ACA, as shown by the House passing its version of the bill, although narrowly. House Speaker Paul Ryan had called that effort all but dead after he had to cancel a vote because there was not enough support. After a few small changes, however, he was able to push the bill through. Opponents of the BCRA are watching for something similar and pushing for voters to keep voicing their concerns.
Part of the challenge for McConnell is that the opposition is coming from more conservative Republicans who think the cuts are too harsh and would worsen the opioid epidemic, as well as from far-right members who think the cuts don’t go far enough and want a full repeal of the ACA.
Changes to the BCRA that have been discussed include adding more funding to fight opioid addiction, extending the phasing out period of Medicaid expansion and cutting more ACA regulations.
Cruz has proposed a change to the law that would allow payers to sell plans that don’t meet the ACA’s regulatory standards, as long as they sell at least one plan that does. The proposal has appealing aspects for the hard-right and more moderate Republicans, but health policy experts say it would likely only benefit the young and healthy. People with pre-existing conditions would go the policy that meets ACA regulations, and its premiums would skyrocket.
The Senate will go on its month-long summer break at the end of this month, so time for negotiation is short. Trump only added to the pressure Monday morning with a tweet stating he expects a bill to be approved before the break.
I cannot imagine that Congress would dare to leave Washington without a beautiful new HealthCare bill fully approved and ready to go!— Donald J. Trump (@realDonaldTrump) July 10, 2017