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September 12, 2017

The GOP still could repeal the ACA this month. Here's the last-ditch plan.

Daily Briefing

    Republican Sens. Bill Cassidy (La.) and Lindsey Graham (S.C.) this week are expected to unveil a proposal to repeal and replace major portions of the Affordable Care Act (ACA).

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    According to a summary draft of the bill and an explanation of the funding formula obtained by NBC News, the measure would maintain a significant portion of the Better Care Reconciliation Act (BCRA), which the Senate in July failed to pass. For instance, the proposal would repeal the ACA's individual and employer mandates retroactively to 2016, as well as the ACA's taxes on health savings accounts (HSAs), medical devices, and over-the-counter medications.

    However, unlike BCRA the proposal would alter federal funding for Medicaid so that, by 2026, there would be parity in federal funding for states that expanded Medicaid and states that did not. The proposal would repeal the ACA's Medicaid expansion on Dec. 31, 2019, and beginning in 2020, all states would receive the same "base" funding "per-person" provided via block grants. The proposal would allocate about $1.2 trillion for Medicaid from 2020 to 2026.

    Further, the bill would change the way the federal government funds subsidies U.S. residents can receive under the ACA to help offset their coverage costs. Instead of providing the subsidies for exchange enrollees on an individual basis, the federal government instead would provide states with block grants intended to fund the subsidies. The bill also would allow states to permit insurers to sell low-cost catastrophic health plans and expand the use of HSAs.

    Tight timeline

    According to Politico's "Pulse," Cassidy said he and Graham are hoping to release the bill Wednesday.

    The senators said they will seek to advance the bill under a budget resolution that would allow the measure to be approved with a simple-majority vote, giving them just weeks to do so before the budget resolution expires on Sept. 30. The bill likely will need to be scored by the Congressional Budget Office, which can take weeks, and reviewed by the Senate parliamentarian, according to Vox.

    It is not clear whether the bill would have enough support to move forward in the Senate or whether leadership will take up the measure, NBC News reports (Mangan, CNBC, 9/11; Caldwell, NBC News, 9/11; Bryan, Business Insider, 9/11; King, Washington Examiner, 9/11; Scott, Vox, 9/12; Diamond, "Pulse," Politico, 9/12).

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    The implementation of MACRA is the most notable change to Medicare physician payment in over a decade. Passed with bipartisan support, MACRA changes the way Medicare pays clinicians.

    Check out our infographic to see the no-regrets strategies to prepare your organization for success under MACRA.

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