ACA Repeal-Only Bill Fails in Senate

Disclosures

July 26, 2017

For the second time within 24 hours, the Senate today rejected a Republican bill to undo the Affordable Care Act (ACA).

The bill, called the Obamacare Repeal Reconciliation Act (ORRA) of 2017, would strike down key portions of the ACA, such as the tax penalty for not obtaining coverage, premium subsidies for individual plans, and Medicaid expansion, but not replace them with another set of reforms. And some repeal provisions wouldn't take place until 2020, giving lawmakers time to craft a replacement law.

The ORRA fell short of passage, with 55 senators voting against it, and 45 voting for it. Seven Republicans joined 48 Democrats and two independents in torpedoing the measure.

In 2015, a Republican-controlled Congress passed a similar measure —vetoed by President Barack Obama — in the name of opposing what it deemed a destructive, Big Government takeover of healthcare. This time around, the legislation turned off moderate Senate Republicans who feared that it would pull the rug out from underneath Americans helped by the ACA. The Congressional Budget Office (CBO) estimated that under ORRA, 17 million more people would be uninsured in 2018, and 32 million more would be in 2026.

The bill would preserve some ACA consumer protections, such as the one that prevents insurers from denying someone coverage on the basis of pre-existing conditions, or charging them more for that reason. At the same time, the CBO said, the bill would increasingly destabilize the individual insurance marketplaces, or exchanges, with rising premiums and fewer insurers participating (that's happening now, Republicans argue in their case for repeal). ORRA would reduce the federal deficit by $473 billion over 10 years.

Today's defeat of the ORRA is the second in a row for Senate Republicans determined to fulfil their promise to erase the ACA from the books. Last night, the Senate rejected another bill  called the Better Care Reconciliation Act (BCRA) that would not only repeal the ACA but replace it. Like the ACA, the BCRA offers premium subsidies to help individuals and families buy private plans on the exchanges, but for most people, this assistance would be substantially less, according to the CBO.

The BCRA also would change the Medicaid program drastically. Besides phasing out federal funding for Medicaid expansion in 31 states and Washington, DC, the bill would slow the growth of regular federal contributions to all state Medical programs by capping them. In all, the BCRA would decrease federal Medicaid spending by 26% through 2026 compared to the trajectory under current law, a move harshly criticized by organized medicine. The CBO estimates that the bill would add 22 million more Americans to the ranks of the uninsured by 2026.

The BCRA resembles a repeal-and-replace measure passed by the House in May. The Senate is using the House bill, the American Health Care Act, as a legislative slate to write its own reforms, taking the shape of sweeping amendments.  The BCRA and the ORRA were the first two amendments considered. Senate Republicans will proceed to others this week in hopes of arriving at legislation they can pass and send to the House for a vote, or to a House Senate conference committee, which would try to draft a compromise bill.

One amendment expected to surface is a "skinny" repeal of the ACA, which would eliminate tax penalties for those who do not obtain insurance coverage, and for employers who do not offer it, and a tax on medical device makers. The idea behind this minimalist measure is that it has the best chance of winning 50 Republican votes and keeping the party's reform efforts alive.

Senate Republicans have found it hard to agree because more conservative members of the caucus want a complete repeal of the ACA together with its taxes and mandates, while more moderate colleagues don't want to lose coverage gains achieved under the law.

Follow Robert Lowes on Twitter @LowesRobert

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