EDITOR’S NOTE: Contributing to this article was Rhonda Buckholtz, a member of the HIMSS professional development committee.

Two text versions of the Senate bill to repeal and replace the Patient Protection and Affordable Care Act (ACA) are expected to be revealed today with the Congressional Budget Office (CBO) scheduled to conduct an analysis on Monday.

Senate Majority Leader Mitch McConnell (R-Ky.) anticipates that there will be a vote next week on the Better Care Reconciliation Act (BRCA). Under reconciliation, the BRCA needs 50 votes to start debate on the Senate bill.

In the meantime, some media outlets are saying up to 10 Republican senators might cast a no vote. Next week there could be a procedural vote to advance the bill to the floor of the Senate and begin consideration of the legislation.  The Senate is racing against the clock with the August recess pending. 

This week, however, House and Senate lawmakers returned from the Fourth of July recess, with many leaving behind the wrath of constituents speaking out on concerns about the BRCA.  On Monday, there was television news coverage of protestors who were on Capitol Hill camping out in front of certain senators’ offices.   

There are television commercials airing as well from a group called “Save our Care” in states where the senators may be on the bubble for voting for the BRCA. The CBO did score the bill a few weeks back and found 22 million more uninsured over time, mostly low- and moderate-income residents with a budget deficit reduction of $321 billion (versus $202 billion for the House bill, the American Health Care Act [AHCA]). 

While premiums would be reduced in the individual market in the long run, coverage would have high deductibles and in waiver states contain fewer benefits.  There would be a five-year ramp down of current Medicaid benefits, and the federal match would, by 2023, go down to 75 percent There are other Medicaid changes, too.  While essential health benefits remain the same as under the ACA, states can ask the Centers for Medicare & Medicaid Services (CMS) for Section1332 State Innovation Waivers. 

Pre-existing conditions remain the same as the ACA. There is some premium assistance in the BRCA and other things in the bill include repeal of individual and employer mandate.  Most of the taxes that were generated through ACA would be repealed, including the medical device tax, prescription tax and even the tanning tax.  In addition, the prevention and public health fund would be cut from appropriations after 2018. 

A number of groups, such as American Association of Retired Persons (AARP) and the American Medical Association (AMA), strongly oppose the bill due to concerns with patient access to needed care. 

The challenge for Senator McConnell is to balance the competing interests within the Republican Senate. For example, there is Senator Ted Cruz (R-Texas), who tends to be more conservative. The summary of his Consumer Freedom Option says, “If an insurer sells at least one Obamacare-compliant plan on a state’s exchange, that insurer would be permitted to sell any other plan that consumers want.”  No legislative language has been circulated yet for this amendment. 

More moderate Republicans, such as Senators Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska), are concerned about the Medicaid provisions in the proposed legislation. There is also President Donald Trump’s tweet that there should just be repeal (and not repeal and replace) for now. 

Of course, then there are the Democrats, who don’t want to help the other party repeal President Obama’s signature healthcare legislation. 

Prior to last week’s recess there were also concerns on the part of a number of senators on the lack of transparency in how the BRCA bill was drafted by a relatively small group of senators. 

So, stay tuned.

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