The Republican leadership’s plan to repeal and replace Obamacare — or just repeal it, depending whom you ask — ended the week in a state of flux that has left more questions than answers.
Consider what has happened just since Monday. Two plans have seemingly fallen apart, then been at least partially revived. The Congressional Budget Office issued scores on two different bills. And President Donald Trump adjusted his desired outcome for the debate three different times.
One thing is clear, however: The Better Care Reconciliation Act (BCRA), the GOP bill to repeal and replace the law known as Obamacare, does not appear to be any closer to passage than it was at the start of the week.
On Friday, after a week of twists and turns, the BCRA got more bad news: The Senate parliamentarian ruled that many of its key provisions, under Senate rules, would require 60 votes to pass. That will likely mean some provisions aimed at enticing Republican members will need to be stripped from the bill.
“This will greatly tie the majority leader’s hands as he tries to win over reluctant Republicans with state-specific provisions,” Senate Minority Leader Chuck Schumer said. “We will challenge every one of them.”
What is the plan?
Led by Senate Majority Leader Mitch McConnell, Republicans appear to be pushing two different plans.
One is the BCRA, which would repeal Obamacare and immediately replace it. It’s the plan that the GOP conference has been haggling over for the past several weeks.
The legislation appeared to be no longer viable as of Monday, when two more Republican senators said they would not vote for a key procedural vote to bring it to the floor. It meant four GOP defections from the legislation, two more than leadership could afford to move the legislation forward.
The other plan is the Obamacare Repeal Reconciliation Act (ORRA), which would repeal Obamacare with a two-year delay with no immediate replacement. McConnell said the delay would give enough time for Congress to come up with a replacement plan.
Leadership and rank and file Republicans so far haven’t confirmed which of these plans is going to be advanced to a vote, but they’re targeting movement next week.
What would be the effect of the plans?
- Coverage: The ORRA would result in 32 million more uninsured Americans by 2026 than under the current system. That number is 22 million under the BCRA.
- Premiums: With no replacement, average premiums in the individual market would double by 2026 under the ORRA. Under the BCRA, premiums would decrease by 30%, but out-of-pocket costs would soar for older and sicker people.
- Deficit reduction: The ORRA would lead to $US473 billion in deficit savings for the federal government through 2026. The BCRA would result in $US442 billion in savings over the same timeframe. Most of the savings would come from cuts to the federal Medicaid program.
The CBO’s score of the BCRA did not include a key provision advanced by Sen. Ted Cruz. The Consumer Freedom amendment would allow insurers to sell plans that do not abide by two major Obamacare regulations. Health experts say the provision could undermine protections for people with preexisting conditions and cause trouble in the individual insurance market.
Are there enough votes for either plan?
It doesn’t seem that way.
On Wednesday night, Republican senators held an emergency meeting and left without a consensus. Additionally, neither Sen. Susan Collins nor Sen. Rand Paul were present at the meeting. Both Republicans have been vocal in their distaste for the BCRA in all of its iterations so far.
In terms of the repeal and delay plans, it doesn’t seem that the three senators who opposed it on Tuesday — Collins, Lisa Murkowski, and Shelley Moore Capito — have changed their opinion in the interim. Additionally, reports have indicated that many more members could vote against the plan if it got to the floor.
The advancement of two different plans does seem to have caused some confusion among the conference, but it appears the primary goal is trying to find a deal on the BCRA.
Complicating factors is the absence of Sen. John McCain, who announced his brain cancer diagnosis on Wednesday night. McCain promised to return to the Senate soon, but it’s unclear when While it is a difficult situation, there is also the political reality that any healthcare plan can only lose a single vote in order to pass now. This makes passage even more improbable.
Sen. John Cornyn, the second-highest ranking member of the GOP leadership, has said senators will take a key procedural vote early next week. Also on Thursday, Sen. John Thune, another member of the leadership, was asked by reporters which plan would be introduced after the motion.
“Who knows?” he said.
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