Despite Setback to BCRA, Senate Leader Pivots to Repeal ACA, and Delay Replacement

Despite Setback to BCRA, Senate Leader Pivots to Repeal ACA, and Delay Replacement

If you are like me, you probably were not expecting two senators to come out against BCRA 2.0 last night and scuttle Senate Majority Leader Mitch McConnell’s (R-Ky.) plan to open debate on that bill as early as next week.

While certainly a positive development, McConnell immediately pivoted to resurrect an earlier repeal-without-replace strategy. According to various news reports, McConnell is calling for a vote to repeal the Affordable Care Act with a 2 year delay to allow Republicans to come up with a replacement (although efforts over the past six months have not given much hope to the notion they could agree on a replacement bill).

In technical terms, he would open debate on AHCA (the House-passed repeal bill) and then offer an “amendment in the nature of a substitute” of the 2015 reconciliation bill. He still needs 50 votes to start debate.

H.R. 3762, the “Restoring Americans’ Healthcare Freedom Reconciliation Act”, was passed by both the House and Senate in 2015 and then vetoed by President Obama.

Speaking from the perspective of an organization that has worked to protect and defend Medicaid for nearly 50 years, it is a huge relief that BCRA’s Medicaid per capita caps – which would have completely decimated Medicaid’s historical funding mechanism – have been defeated. H.R. 3762 does not impose per capita caps. But if McConnell gets 50 votes to open debate, any amendment that addresses the budget deficit is fair game so any senator could conceivably try to add per capita caps via an amendment. Plus, H.R. 3762 includes enough other devastating changes to Medicaid as well as repealing the ACA that we do not want that door opened even a crack.

When the Congressional Budget Office (CBO) scored H.R. 3762, it estimated 18 million would lose coverage in the first year and 32 million people would lose coverage after 10 years. That’s 10 million more than BCRA. How? Because H.R. 3762 would leave the ACA’s market reforms in place (requiring essential health benefits, prohibiting lifetime/annual caps and exclusions based on pre-existing conditions, etc.) but repeal the ACA’s subsidies and penalties. CBO estimated premiums would go up 20-25 percent in the first plan year following enactment, up to 50 percent after the end of Medicaid expansion and subsidies, and double within 10 years.

H.R. 3762’s changes to Medicaid include:

  1. Repeal Medicaid expansion 2 years after enactment (with no phasing down of funding) resulting in 19 million losing Medicaid coverage;
  2. Repeal mandatory Medicaid coverage for children ages 6 to18 and move these children into the Children’s Health Insurance Program (CHIP);
  3. Repeal enhanced funding for Community First Choice attendant supports, a cut of $19 billion;
  4. Defund Planned Parenthood for a year;
  5. Repeal the maintenance of effort requirements in CHIP (due to expire in 2019);
  6. Repeal essential health benefits for Medicaid expansion enrollees; and
  7. Repeal enrollment simplification and coordination with marketplace requirements for Medicaid.

On the private insurance side, H.R. 3762 would:

  1. Repeal premium tax credits after two years and eliminate repayment caps if individuals receive more advanced tax credits than they were eligible for;
  2. Repeal cost-sharing reductions after two years;
  3. Effectively repeal the individual and employer mandates by setting the penalty to $0;
  4. Provide tax cuts to the wealthy and corporations by repealing the ACA taxes; and
  5. Immediately stop funding for the Prevention and Public Health Fund.

Many senators expressed their opposition to repeal without replace earlier this year. So did the president despite his recent tweets. Senator Shelley Moore Capito (D-W.Va.) reiterated her opposition today, as did Senator Lisa Murkowski (R-Alaska), and we hope others will soon follow. We need to ensure this bill does not get 50 votes to open debate as repeal without replace would immediately destroy the individual insurance market and could put “regular” Medicaid back on the chopping block. Call your senators today to urge them to vote “no” on any bill that repeals the ACA and destroys Medicaid.

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