Senate's Last "Gasp" Effort to Repeal and Replace the ACA

Republicans are making a last “gasp” effort to pass “repeal and replace” legislation in the Senate, before the “reconciliation” clock runs out. A new health care “repeal and replace” bill, introduced by Sens. Lindsey Graham, (R-S.C.), Bill Cassidy, (R-La.), and others will be slated for a vote next week. This bill, like earlier Senate versions, would repeal the employer and individual mandate, and eliminate others taxes such as the medical device tax. It’s most controversial provision relates to how the Medicaid expansion of the Affordable Care Act (ACA) and the states' premium support subsidies will be allocated. The bill provides that the current system under the ACA will convert into block grants for each state, with control of grant allocation shifting to each state. As with the earlier “repeal and replace” bills in the Senate, this bill does not have bi-partisan support, Democrats, medical groups and some insurance companies already expressing their opposition to the bill.

Specifically, this bill, in addition to repealing the individual and employer mandates, would reallocate the current subsidies provided to states starting in 2020. The bill provides that the funds would be allocated based on a combination of per-capita eligibility and actual enrollment numbers in state health care coverages. Specifically, states would receive a portion of the $1.2 trillion of existing ACA spending through 2026 on a per-capita rate based on their proportion of the population that earns less than 138 percent of the federal poverty level. According to the Sens. Graham and Cassidy, this bill allows states the freedom to innovate on health care policy. Sen. Rand Paul, (R-Ky.), has already stated that he will not vote for the bill, and Sens. John McCain, (R-Ariz.), Susan Collins, (R-Maine), and Lisa Murkowski, (R-Alaska), have withheld their support. (As a side note, these Senators also voted “no” on the prior versions of “repeal and replace.”)

As a reminder, next week is the last week that the “reconciliation” process may be used by the Republicans, allowing the bill to be passed with a simple majority. The Senate Finance Committee has scheduled a hearing on the legislation for Monday, and a spokesman for Senate Majority Leader Mitch McConnell, ( R-Ky.), said the Senate would vote on the measure next week.

The bill, which has not yet been scored by the Congressional Budget Office, has the support of President Donald Trump, but may not have the votes to pass in the Senate. Of course, even if the bill passes in the Senate, it is not ready for the President to sign, as it must be reconciled with the House version of “repeal and replace," the American Health Care Act of 2017, passed by the House earlier this year.

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