It's been an eventful 24 hours in the Senate: The Senate on Tuesday narrowly voted 51-50 to open debate on health reform—even though Republicans had not reached any consensus on which health reform bill they will seek to turn into law.
Hours later, the Senate voted down the wide-ranging Better Care Reconciliation Act (BCRA), and on Wednesday they delayed by about three hours an expected vote on a narrower "repeal-and-delay" bill.
The first proposal considered: Modified BCRA
After a few hours of debate on Tuesday evening, the Senate voted 43-57 against the first of Senate GOP leaders' proposed health reform plans: an updated version of the BCRA.
The BCRA is the Senate's broadest health reform bill and would repeal and replace major parts of the Affordable Care Act (ACA), as well as restructure and reduce funding for Medicaid by turning it into a per capita allotment model. The measure brought to the floor for a vote included two new amendments:
- One offered by Sen. Ted Cruz (R-Texas), which would have allowed insurers that sell at least one ACA compliant plan to also sell plans that do not comply with the ACA's coverage mandates; and
- A proposal offered by Sen. Rob Portman (R-Ohio), which would have included an additional $100 billion in one-time funding that states could use to help cover the costs of care for certain Medicaid expansion beneficiaries who would be moved to private coverage in 2020, when BCRA would eliminate the ACA's enhanced federal Medicaid funding.
Because the measure included provisions that do not comply with the strict rules of the Senate reconciliation process, it required at least 60 votes to pass. Ultimately, nine GOP senators— Susan Collins (Maine), Bob Corker (Tenn.), Tom Cotton (Ark.), Lindsey Graham (S.C.), Dean Heller (Nev.), Mike Lee (Ariz.), Jerry Moran (Kan.), Lisa Murkowski (Alaska), and Rand Paul (Ky.)—joined all Democrats in voting against the measure.
According to the Wall Street Journal, the GOP senators' defections "underscored the lack of support within the party for the ACA replacement that leaders had cobbled together." According to Axios, a senior GOP aide said a different version of BCRA, such as the latest one scored by the Congressional Budget Office (CBO), could still be offered later in the process.
The Senate adjourned around 10 p.m. Tuesday after the failed vote, the New York Times reports.
Next up: Repeal-and-delay
When the Senate reconvened Wednesday, lawmakers at noon were expected to take up the second of Senate GOP leaders' health reform plans: a repeal-and-delay measure. However, that vote has been delayed until 3:30 p.m., according to the Times.
The bill, called the Obamacare Repeal Reconciliation Act of 2017, would immediately repeal major ACA provisions, including the law's coverage mandates and some of the law's tax increases, and in 2020 it would eliminate funding for the law's Medicaid expansion and insurance premium subsidies. Unlike the BCRA, the bill would not overhaul the Medicaid program and would not immediately replace the ACA, instead aiming to give Congress more time to come up with a path forward. CBO last week said the bill would leave 32 million more individuals uninsured and cause premiums in the non-group market to rise by about 50 percent by 2026, when compared with current law.
According to the Times the measure is not expected to pass. However, according to Politico's "Pulse," McConnell had promised conservative senators such as Paul the opportunity to vote on a straight repeal bill in exchange for their support for the initial motion to proceed to debate.
Backup plan: A 'skinny' bill
Senate Republican leaders also are now reportedly considering a narrower proposal in an effort to pass a shell that would open broader negotiations between the House and Senate. According to GOP senate aides, the narrower bill likely would repeal only the ACA's individual and employer mandates and medical device tax.
The move also could give CBO more time to score some of the newer Republican proposals, including those offered by Cruz and Portman, the Wall Street Journal reports (Kaplan/Pear, New York Times, 7/25; Scott, Vox, 7/25; Owens, Axios, 7/25; Kaplan/Sullivan, New York Times, 7/26; Armour et al., Wall Street Journal, 7/25; Diamond, "Pulse," Politico, 7/26; Baker, "Vitals," Axios, 7/26).
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