After a slim victory in the House, healthcare reform faces more debate — and changes — in the Senate.
After a narrow 217-213 victory in the House of Representatives, the rewritten GOP-backed American Health Care Act (commonly known as AHCA) now moves to the Senate where it’s expected to undergo even more revisions. Several Republican senators have already signaled their reluctance to approve the bill in its current form, which means it’s up to Senate Majority Leader Mitch McConnell (R-KY) to cobble together a measure acceptable to hard-line conservatives and moderate factions of the Republican party.
According to The Hill, McConnell has convened a working group of about a dozen GOP senators to study the proposed legislation. “Obamacare has failed the American people and must be repealed and replaced,” he said in a statement. “As Congress considers this legislation, the administration will continue working to deliver relief and stabilize health markets, and Congress will continue to act on legislation to provide more choices and freedom in health care decisions.”
A Different AHCA?
After several attempts stalled in the House, the Freedom Caucus, a coalition of far-right congressmen, worked with moderate representatives to craft the bill that ultimately passed. Revisions focused on replacing the Affordable Care Act’s (ACA) subsidies and taxes with individual tax credits, rolling back Medicaid expansion, and allowing states to determine essential healthcare benefits. These modifications, supporters assert, would boost free market competition, lower premiums, and provide consumers with more choice.
Also, under the reworked bill, states could apply for a waiver from the community rating provision in the ACA that restricts insurers’ ability to charge older people and those with pre-existing conditions higher premiums. States granted the waiver would a share from a $8 billion pot dispensed by the federal government to defray the cost of insuring older, sicker people in high-risk pools.
Many moderate Republicans, however, predict that those components, if passed, would hike up healthcare costs for older Americans and make insurance for people with chronic medical needs unaffordable. Sen. Susan Collins (R-ME) told Time.com any bill should impose “no barrier for coverage” for people with pre-existing health conditions.
Sen. Rob Portman (R-OH) expressed concerns over how the roll back of the Medicaid expansion would impact people in his state, particularly those receiving care for opioid addiction. “I’ve already made clear that I don’t support the House bill as currently constructed,” he said.
Conservative senators, meanwhile, also want to see changes in the House’s version of the AHCA. Sen. Ted Cruz (R-TX) told Fox News that senators “should continue to improve the bill.” Questions over payments to insurance companies have Sen. Rand Paul (R-KY) withholding his full-fledged support. “It’s going to take a little bit of work to get me to a yes vote, but I do have an open mind,” he told Fox News.
No Timeline for Passage
Even if the senate approves a likely amended version of the AHCA, it must go back to the House for reconciliation. So far, senate leaders have yet to commit to a floor debate date, which won’t happen until the Senate receives a fiscal review from the Congressional Budget Office. McConnell ally Sen. John Cornyn (R-TX) told the Wall Street Journal no timeline has been set for a senate vote. “When we get 51 senators, we’ll vote,” he said.
Republicans currently control the Senate by 52 to 48 seats. Typically, senate bills require a majority vote of 60; however, Sen. McConnell is reportedly considering allowing the bill to pass with a simple majority, meaning it could pass with 51 votes or end in a 50-50 deadlock with Vice President Mike Pence casting the tie-breaking vote.
The senate vote has implications for health insurers, who must submit their ACA marketplace plans for federal review on June 21. Sen. Chuck Grassley (R-IA), Chairman of the Judiciary Committee, told The Hill that it’s unlikely that the AHCA would be passed prior to that deadline. “I said there’s no assurance I can give you from a substance standpoint or a process standpoint for when that’s going to happen because there’s been such little discussion,” Grassley said.
As the senate considers and votes on the AHCA, your clients await definitive answers on their health insurance plans. But until a final law is enacted, the best advice you can give your clients is to maintain their current coverage.