ACA Repeal Advances In Senate
The Senate has begun a series of votes relating to the potential repeal of the Affordable Care Act (ACA). On July 25, majority leader Mitch McConnell followed through on his promised procedural vote to take up the bill that passed in the House two months ago. Senator McCain, recently diagnosed with brain cancer, flew to Washington D.C. and voted in favor. Two Republican Senators voted against it: Susan Collins of Maine and Lisa Murkowski of Alaska. That vote passed 51-50, with Vice President Mike Pence casting the deciding vote.
The Senate immediately began considering multiple amendments and substitutes for the House bill, and considerations are expected to continue through Friday, July 28. Tuesday night, the Senate rejected the most recent version of the Republican plan to repeal and replace the ACA, with only 43 votes in favor. That bill contained the Cruz amendment, which allowed insurers who offer one ACA compliant plan to also sell cheaper insurance options that don’t meet ACA requirements. On Wednesday, a separate bill to repeal the ACA without a replacement, but allow two years for a replacement to be worked out, also failed, 45-55.
A so-called “Skinny Bill” has received some attention. In contrast to a more comprehensive bill that would repeal and replace the ACA, the Skinny Bill, as presently understood, would simply repeal the ACA individual and employer mandates, as well as the medical device tax. The Skinny Bill appears to contemplate leaving ACA subsidies in place. The Skinny Bill is also being referred to as the “lowest common denominator” proposal.
There is significant concern that the Skinny Bill will fatally undermine the individual insurance markets, causing substantial disruption and escalation of costs. The Blue Cross Blue Shield Association statement on the Senate healthcare efforts offered that “a stable individual insurance marketplace” requires any final legislation to include “strong incentives for people to obtain health insurance and keep it year round,” assistance for those in need with out-of-pocket costs, and funding for those with pre-existing conditions. Such elements of any bill are essential to “avoid steep premium increases and diminished choices that would make coverage unaffordable and inaccessible.”
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