Understand how we got here — and how to move forward.


July 11, 2017

Senate GOP leaders say revised health reform bill could drop this week

Daily Briefing

    Senate GOP leaders are hoping to hold a vote next week on their health reform legislation.

    New: 3 steps to establishing an intentional Medicare risk strategy

    Senate Majority Whip John Cornyn (R-Texas) on Monday said an updated version of the legislation, called the Better Care Reconciliation Act (BCRA), could be released within the next few days. According to Axios, senior GOP aides said revisions could come as soon as Thursday. Senate GOP leaders on Tuesday are expected to brief Republicans in the chamber on the revised bill, The Hill reports.

    Once the bill is released, the Congressional Budget Office will have to score the measure, and that score could be available early next week, according to the Journal. Senate Republican leaders then could look to schedule a vote on the measure. Cornyn said, "We need to start voting."

    Looking for a consensus

    However, GOP senators still have to reach a consensus on the legislation, and some stakeholders say the revised bill might not go far enough to gain the support needed for Republicans to pass it, the Wall Street Journal reports. Republicans senators can lose only two votes on BCRA if all Senate Democrats vote against the bill, as is expected.

    GOP leaders are expected to add $45 billion to the bill to help states address the U.S. opioid misuse epidemic amid some GOP senators' concerns that BCRA's proposed Medicaid cuts ultimately could worsen the crisis. One such lawmaker, Sen. Susan Collins (R-Maine), has said while the additional funding would be "helpful," it is "by no means sufficient" in light of the Medicaid cuts.

    In addition, some Senate Republicans remain divided on an amendment proposed by GOP Sens. Ted Cruz (Texas) and Mike Lee (Ariz.) that would allow insurers that offer at least one health plan that complies with all of the Affordable Care Act's (ACA) rules—including its essential health benefits requirements and its provision barring insurers from charging individuals with pre-existing conditions more for coverage—to also sell lower-cost plans that do not meet the ACA's requirements.

    According to the Journal, conservative lawmakers have rallied around the provision, but some moderate Republicans have expressed concerns about how the amendment could affect premiums for individuals with pre-existing conditions.

    Despite those differences, some Senate Republicans have said they are confident Senate Majority Leader Mitch McConnell (R-Ky.) will strike a deal that gets the 50 votes needed to advance BCRA. Sen. Pat Toomey (R-Pa.) during a CNBC interview on Monday said, "There's a path to bringing the moderates on board" and "there's still a path" to approving the bill.

    Others expressed a less optimistic view. For instance, Sen. John McCain (R-Ariz.) during an interview with CBS' "Face the Nation" on Sunday said he believed BCRA "probably" would "be dead."

    Further, some GOP senators voiced concerns about Republican Senate leaders' new timeline for voting on the legislation. Sen. John Hoeven (R-S.D.) said, "We're going to want to see the amendments, and we're also going to want to make sure that we have a chance to see what the score is and understand it. And then also, we're going to want to be able to talk to people in the industry." He continued, "It's going to take some time to work through that and understand that."

    According to Politico, a spokesperson for McConnell did not give any announcements regarding when the Senate might consider BCRA.

    Trump pushes for health reform vote before Congress' August recess

    Meanwhile, President Trump is putting pressure on Senate Republicans to vote on health reform legislation before Congress' August recess begins, the Journal reports.

    Trump in a tweet Monday wrote, "I cannot imagine that Congress would dare to leave Washington without a beautiful new health care bill fully approved and ready to go!"

    Some GOP lawmakers have suggested that Congress should cancel or shorten the August recess if progress on health reform legislation is not made by then, the Associated Press reports (Peterson, Wall Street Journal, 7/10; Carney, The Hill, 7/10; Fram/Werner, AP/Sacramento Bee, 7/11; Collins, USA Today, 7/10; Williams, Roll Call, 7/10; Everett et al., Politico, 7/10; Owens, Axios, 7/11).

    Is your Medicare risk strategy MACRA-ready?

    While the GOP's health reform effort continues to evolve, Medicare payment reform has quietly marched on with bipartisan support. And with MACRA well underway, the new administration has shown no signs of reversing course.

    As a result, hospital and health system leaders need to develop an intentional Medicare risk strategy today.

    Check out our new research report to learn how to navigate the Medicare ACO programs, expand into the Medicare Advantage market, and ensure the longevity of your Medicare risk strategy by actively cultivating contracts over time.

    Download the Report

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.