UPDATE: Senate Republicans will delay the vote on the Senate healthcare reform bill until after the July 4 recess, Axios reported. Senate Majority Leader Mitch McConnell was hoping to get a vote on the bill this week. However, enough senators wavered their support for the bill after the CBO score on the bill was released that McConnell delayed the vote.
- The Senate version of the American Health Care Act (AHCA) would result in 15 million people losing insurance as soon as next year and 22 million in the next 10 years, according to an analysis from the Congressional Budget Office (CBO). If the bill passes, “few low income people would purchase any plan,” because of an actuarial benchmark change, according to the analysis.
- The score was of a slightly revised text of the Senate version of the American Health Care Act, which it calls the Better Care Reconciliation Act (BCRA). The main change from the Senate bill first released Thursday morning is a penalty for people who drop coverage. A person who goes without insurance for two months would be locked out of the market for the following six months.
- The American Medical Association released a letter Monday strongly condemning the bill because it violates the “first, do no harm” standard, and the National Association of Medicaid Directors said it “would be a transfer of risk, responsibility and cost to the states of historic proportions.” Also, a group of 40 economists, including six Nobel laureates, sent a letter opposing the bill.
The numbers in the CBO score aren't particularly surprising because the Senate's BCRA didn't differ substantially from the House’s AHCA, which had already been scored. However, the speed with which people would lose coverage and the numerous ways in which out-of-pocket costs would likely increase for many may give senators on the fence about the legislation further pause.
McConnell attempted to push for a vote on the bill this week, but he has only a few ways to get to 50 votes. A handful of senators from each of the wings of the GOP are holding their support, although for very different reasons. Three senators said they will not vote to approve even debate of the bill, called a motion to proceed.
I want to work w/ my GOP & Dem colleagues to fix the flaws in ACA. CBO analysis shows Senate bill won't do it. I will vote no on mtp. 1/3— Sen. Susan Collins (@SenatorCollins) June 26, 2017
The CBO analysis suggests the individual market would be stable beyond 2020, just as it would with the Affordable Care Act (ACA), but premiums would rise faster in the near term and deductibles would increase significantly. The Senate bill would cause 4 million people to lose employer-based coverage next year because of the individual mandate being removed.
Republicans get one of their main goals with the legislation in that it would reduce the aggregate federal deficit by $321 billion from 2017 to 2026.
The AMA’s letter of opposition is particularly forceful and in line with other major industry groups like the American Hospital Association as well as numerous physician subspecialty organizations. One payer did come out Monday with support for at least some provisions of the Senate bill. Anthem said it believes the bill “will markedly improve the stability of the individual insurance market.”
The heavy and immediate coverage losses would certainly have implications for hospitals. More uninsured people means larger uncompensated care burdens and lower patient volumes. An analysis from Fitch Ratings suggests acute care hospitals would be hardest hit. While the tax repeals would boost financial returns for many companies in the short term, "that initial positive benefit will evaporate as higher uninsured rates will be an important structural headwind to topline growth for healthcare companies over the longer term," it concludes.