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Straight Talk for Seniors®: Senate Repeal Bill Collapses

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UPDATE as of July 25, 2017: The Senate is expected to vote today to proceed with debating a health care repeal bill. Senate Majority Leader Mitch McConnell (R-KY) has promised Senators that if they vote for the “Motion to Proceed,” they will have an opportunity to offer amendments. The goal is to get a revised version of the Senate bill that will garner enough votes to pass. Currently, the only firm vote against the Motion to Proceed is Sen. Susan Collins (R-ME). Key swing votes include Sens. Lisa Murkowski (R-AK), Shelley Moore Capito (R-WV), Rob Portman (R-OH), and Dean Heller (R-NV). Below is what happened last week.

The latest Senate attempt to repeal the Affordable Care Act (ACA) and cut and cap Medicaid has collapsed. And a likely new strategy to repeal the ACA without any details on how to replace it also appears doomed.

Last week, Sens. Susan Collins (R-ME) and Rand Paul (R-KY) publicly opposed the Senate Better Care Reconciliation Act (BCRA). With a 52-48 margin and every Democrat opposing the bill, only one more Republican no vote was needed to defeat it.

Last night, conservative Sens. Mike Lee (R-UT) and Jerry Moran (R-KS) voiced their opposition, effectively ending consideration of the bill.

Shortly afterward, Senate Majority Leader Mitch McConnell (R-KY) outlined his proposed next steps. “Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful,” he said in a statement. He added that “in the coming days,” the Senate would vote to take up “what a majority of the Senate has already supported in 2015 … a repeal of Obamacare with a two-year delay to provide for a stable transition period to a patient-centered health care system that gives Americans access to quality, affordable care.”

Repeal and delay?

Many interpret these comments as a plan to resurrect H.R. 3762, the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, often referred to as the “repeal and delay” proposal. It passed Congress in late 2015, but was vetoed by President Obama on Jan. 8, 2016.

Earlier this year, when the House and Senate began considering their ACA repeal proposals, they were concerned that “repeal and delay” would negatively affect insurance coverage and out-of-pocket costs. They decided instead to “repeal and replace,” but that effort has proven unsuccessful.

According to the nonpartisan Congressional Budget Office (CBO), the 2015 bill would have increased the number of uninsured Americans by 18 million in the year following enactment and by 32 million within 10 years. That’s 10 million more uninsured than under the now defunct BCRA. Premiums for the nongroup market would have increased by 20-25% in the year following enactment and increase 100% within 10 years.

While the 2015 bill did not include Medicaid per capita caps, it repealed the Medicaid expansion, the Medicaid Community First Choice (CFC) program, and the Prevention and Public Fund. It also repealed the 0.9% ACA payroll tax increase on single individuals with incomes over $200,000 and couples with incomes over $250,000, which would have resulted in an accelerated shortfall in the Medicare Hospital Insurance Trust Fund, from 2029 to 2026.

Opposition mounts

The timing of a possible Senate vote on “repeal and delay” is still unclear, but would begin with a vote on a “Motion to Proceed” to debate and amend the bill. Moderate Republican Senators have expressed serious concerns with a delay approach that fails to specify any replacement policy, and that significantly increases the number of uninsured and out-of-pocket costs. The bill also raises particular problems for the 31 states that have expanded Medicaid, many with Republican Senators and Governors.

Already, Sens. Collins (R-ME), Murkowski (AK), and Capito (R-WV) have voiced their opposition to a Motion to Proceed with consideration of the new proposal, and Sen. Portman (R-OH) has expressed concerns about a repeal-only bill.

In addition, a bipartisan group of 5 Republican and 6 Democratic governors has urged the Senate to “immediately reject efforts to repeal the current system and replace sometime later.”

Stay tuned to NCOA Week for updates as the process continues.

What are your thoughts about these latest developments? Share them in the comments section below.

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Howard Bedlin

About Howard Bedlin

Howard Bedlin is NCOA's Vice President of Public Policy and Advocacy. He is responsible for all of NCOA’s federal and state legislative advocacy efforts on issues and programs of concern to older adults, which include the Older Americans Act, Medicare, Medicaid, long-term care, income security, and community services programs.