June 30, 2017

Senate GOP weighs 5 health bill changes—and Trump floats 'repeal then replace'

Daily Briefing

    Senate GOP leaders are still working to reach a deal among conservative and moderate Republicans on the Better Care Reconciliation Act (BCRA).

    Understand the no-regrets priorities at the top of every finance leader's agenda

    Senate Republican leaders had hoped to hold a vote on BCRA this week, but Senate Majority Leader Mitch McConnell (R-Ky.) delayed the vote amid pushback from some conservative and moderate Republicans. McConnell then said he was aiming to reach a consensus on changes to BCRA by Friday so lawmakers could send the revised bill to the Congressional Budget Office (CBO) to score over Congress' July 4 recess and hold a vote shortly after lawmakers reconvene on July 10.

    It appears, however, that this timeline has slipped, too, and that lawmakers will not complete a fully revised bill before they recess.

    Potential changes

    Senate Republican leaders have proposed:

    • Adding as much as $45 billion to BCRA to help address the United States' opioid misuse epidemic;
    • Adding a provision that would allow U.S. residents to use health savings accounts to pay for their health plan premiums; and
    • Keeping in place the Affordable Care Act's (ACA) tax on high-income individuals' investment incomes to generate revenue for more generous premium subsidies for people who purchase exchange plans.

    One Republican lawmaker and lobbyists said GOP senators also are discussing keeping in place other taxes implemented under the ACA, Roll Call reports.

    Senate GOP leaders also could propose additional money for a fund intended to help states offset health care costs for low-income individuals and making that funding available to states sooner. According to The Hill, one Republican senator said Senate GOP leaders could propose adding up to twice as much money for the fund, which under BCRA currently would receive $62 billion over eight years.

    Next steps

    It does not seem likely Senate Republicans will reach a final deal on BCRA by Friday, the Los Angeles Times reports. According to Axios' "Vitals," some moderate GOP senators are still concerned about BCRA's Medicaid funding cuts and want to phase out the ACA's Medicaid expansion more slowly. Meanwhile, some conservative GOP senators still would like BCRA to repeal more of the ACA's insurance regulations, and some could object to keeping the ACA's taxes on U.S. residents with high incomes.

    However, GOP aides said Senate Republican leaders could send an outline of an updated version of the bill to CBO to score while Congress recesses for July 4. If they do, CBO could release a score of the updated bill by mid-July and lawmakers could vote on the bill before Congress' August recess, "Vitals" reports.

    Trump: Lawmakers should repeal, then replace ACA if Senate cannot pass BCRA

    In related news, President Trump on Friday suggested lawmaker should first repeal and then separately replace the ACA if the Senate cannot pass BCRA, the Associated Press reports.

    Trump tweeted:

    However, Senate Republican aides quickly dismissed Trump's proposal. According to Axios, one GOP aide said there is "zero" chance of lawmakers repealing and replacing the ACA in separate steps.

    (Nather/Baker, "Vitals," Axios, 6/30; Owens, Axios, 6/29; AP/Modern Healthcare, 6/29; Williams, Roll Call, 6/29; Bolton/Sullivan, The Hill, 6/29; Bolton, The Hill, 6/29; Mascaro, Los Angeles Times, 6/29; Fram, AP/Sacramento Bee, 6/30; Owens, Axios, 6/30).

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