By: Kristen Gurley, Esq.
Praxis Healthcare Solutions, Staff Attorney
While the GOP has made progress in efforts of repealing the Affordable Care Act (ACA), actual legislation to repeal the ACA has stalled. A vote on health care reform could happen as soon as mid-July depending on when Senate Republicans deliver a new bill to the Congressional Budget Office. Current plans are to deliver a new draft in the upcoming few days and then push for a vote before the August recess. Senate leaders recently announced plans to delay their recess by 2 weeks in attempts to finally repeal and replace the ACA before their long August recess.
The new bill is expected to add provisions to allow insurers to offer “bare-bones” policies that create cheaper alternatives for healthier consumers. However, some warn that these plans would raise costs for those who are not as healthy and leave many with plans that don’t really provide much coverage. Moody’s Investors Service says Senate Republicans’ proposed healthcare bill, dubbed the Better Care Reconciliation Act of 2017 (BCRA), would negatively affect hospital finances by causing the uninsured rate to rise. Some highlights from the BCRA that was recently released are: 1. Cuts to Medicaid by phasing out monies provided to expand federal-state Medicaid programs. 2. Ending penalties for people not buying insurance and larger employers not offering coverage. 3. Largely retaining the subsidies provided to help millions buy insurance (income based). 4. Blocking federal payments to Planned Parenthood. 5. Repealing or delaying tax boosts that helped pay for coverage for approximately 20 million more people, which would result in a tax decrease for higher income people, medical industry companies, and others. 6. Higher premiums for some people with pre-existing serious illnesses.
Many major healthcare providers and advocacy groups fear the bill will destabilize insurance markets and leave many without coverage. Therefore, some lawmakers are vying for a limited bill which would include provisions to continue federal payments to insurers that help contain costs for lower-earning consumer and inducements to keep healthy people buying policies. Former administrators at the Center of Medicare and Medicare Services have suggested that dropping the controversial Medicaid changes for now and considering them later would allow passing of the bill. “Medicaid is too big, too complex, and too important of a program to restructure within this rapid timeframe. Separating reforms would allow focus on stabilizing the individual health insurance market.”
Some lawmakers and President Donald Trump are even insisting to at minimum repeal now and replace later. President Trump tweeted recently that the ACA should be repealed even if the BCRA fails to pass. However, many are skeptic of repeal occurring without a replacement. Repealing the ACA without a replacement might be as much of a challenge as passage of the bill.  Doing so could leave more than 20 million Americans, who now have private health plans or Medicaid coverage under the ACA, without insurance and with no guarantee of any alternative coverage.
The countdown is on to see if the Senate can present a bill that will satisfy the concerns of all sides of the Senate majority in order to gain the necessary votes. It will be interesting to see what provisions actually make it onto the bill that is expected to be presented to the CBO in the upcoming days. At minimum, the Trump administration is hopeful that a repeal can happen before the August recess. However, many disagree with repealing without replacing and skeptics believe that a consensus being reached within this short time frame is just not likely to happen.
 LA Times. (2017, July 10). Senate hopes to vote next week on Obamacare repeal, as Trump pressures Republicans to act. Retrieved July 12, 2017 from, http://www.latimes.com/politics/washington/la-na-essential-washington-updates-senate-to-vote-next-week-on-gop-1499722376-htmlstory.html.
 Becker’s Review. (2017, June 23). Moody’s: Hospital uncompensated care costs will rise under proposed Senate bill. Retrieved June 23, 2017 from, http://www.beckershospitalreview.com/finance/moody-s-hospital-uncompensated-care-costs-will-rise-under-proposed-senate-bill.html
 H. R. 1628. Discussion Draft. (2017) Retrieved on June 22, 2017 from, https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf.
 CNBC. McConnell says a limited health-care bill is needed if Obamacare repeal dies. (2017, July 6). Retrieved July 8, 2017 from, https://www.cnbc.com/amp/2017/07/06/mitch-mcconnell-says-limited-bill-needed-if-obamacare-repeal-bill-dies.html
 JAMA. JAMA Forum: Reforming Medicaid. (2017, July 11). Retrieved July 12, 2017 from, https://newsatjama.jama.com/2017/07/11/jama-forum-reforming-medicaid/.
 Becker’s Hospital Review. Trump encourages ACA repeal even if BCRA fails to pass. (2017, June 30). Retrieved on July 6, 2017 from, http://www.beckershospitalreview.com/hospital-management-administration/trump-encourages-aca-repeal-even-if-bcra-fails-to-pass.html
 Washington Post. Trump’s latest idea: Senate could repeal Obamacare now and replace it later. (2017, June 30). Retrieved on July 6, 2017 from, https://www.washingtonpost.com/news/post-politics/wp/2017/06/30/trumps-latest-idea-senate-could-repeal-obamacare-now-and-replace-it-later/?utm_term=.8ae458c86e84