Senate Republican leadership is set to roll out the updated version of its healthcare bill on Thursday, but continued pushback from its own conference likely puts the legislation in the same perilous position as previous iterations.
The new version of the Better Care Reconciliation Act (BCRA), will be released by Senate Majority Leader Mitch McConnell during a meeting of the Republican conference around 11:30 a.m. ET.
The biggest issue of concern: The new legislation reportedly does not address an approximated $US772 billion in cuts to the Medicaid program through 2026. For many moderate detractors in states with large Medicaid populations, that could be a make or break issue.
Sen. Lisa Murkowski of Alaska has blasted the cuts, which would roll back Obamacare’s Medicaid expansion and cap the amount of funding the federal government provides.
“The ACA allowed for Medicaid expansion. The ACA didn’t address traditional Medicaid. … Why do we not focus on the urgency of the concerns with the ACA?” Murkowski told reporters Wednesday, according to Politico.
Other moderate senators like Susan Collins of Maine, Shelley Moore Capito of West Virginia, and Dean Heller of Nevada also expressed concerns about the new version preserving most of the Medicaid cuts.
On the other end of the GOP spectrum, conservative-leaning members have remained on the fence about their intentions.
Sen. Rand Paul of Kentucky told reporters during a conference call Wednesday that he would not support the bill even after the changes. Paul criticised the “kitchen sink” approach McConnell has taken to win over members by adding new spending to the legislation.
Instead, said Paul, the GOP should “narrow” the bill to a slim partial repeal of Obamacare, addressing the parts the on which the conference could agree.
And an amendment offered by Sen. Ted Cruz that would allow insurers to dodge certain regulations created by Obamacare will be tentatively added to the bill. That will likely help the legislation earn the support of Cruz and Sen. Mike Lee, but it could also help push moderates to oppose the legislation. On Wednesday, a group featuring some of the US’s largest insurers blasted the Cruz amendment, highlighting its potential effects on protections for people with preexisting conditions.
Majority Whip John Cornyn, the No. 2 Republican in the Senate, told reporters on Wednesday night that the bill does not have enough votes to pass. It can only lose two Republican votes. As of now, none of the 10 senators that came out publicly against the original version of the bill said they have moved into the “yes” column.
What to watch for in the bill
Several reports have outlined the changes to the bill that attempt to bring the conference together in agreement.
Here’s a rundown of what changes may be in the new version of the BCRA:
- Keep some of Obamacare’s taxes: The new version could preserve the 3.8% investment income tax on people making over $US200,000 a year, a huge source of revenue from Obamacare and one of the biggest reasons Republicans wanted to repeal the law. That would not sit well with conservatives and anti-tax advocates.
- Increased funding for the opioid crisis: The original bill had $US2 billion in funding to combat the opioid crisis. The new version is expected to increase that number to around $US45 billion.
- The Cruz amendment: An addition from Ted Cruz would allow insurers to sell plans that do not comply with two major Obamacare regulations. Experts worry this could undermine protections for people with preexisting conditions. According to Politico, a modified version of this plan will be included in the bill.
- Increased funding for the state stability fund: This fund is distributed to states to help bring down premiums and start programs that lower costs for insurers and consumers. According to reports, there will be $US70 billion of new money for this fund in the new version of the BCRA.
- Allow people to spend money from health savings accounts on premiums: HSAs, which are not taxed, can be spent on a variety of medical care costs. A new provision would allow it to go toward insurance costs.