June 29, 2017

Earlier this week, Senate Majority Leader Mitch McConnell (R-KY) signaled his intention to bring an Affordable Care Act (ACA) repeal and replacement bill to the floor.  Entitled the Better Care Reconciliation Act (BCRA), the measure – which remains in draft form – modifies some of the provisions of the House-passed American Health Care Act (AHCA; HR 1628).  Similar to the House legislation, the upper chamber’s bill proposes deep cuts to Medicaid and would eliminate the nearly $1 billion Prevention and Public Health Fund used by state and county public health departments.

As the Congressional Budget Office (CBO) prepared its estimate on the Senate bill’s effect on Medicaid and the uninsured rate, some conservative and moderate senators announced their opposition to the legislation in its current form.  Conservatives, such as Rand Paul (R-KY), argued that the bill does not go far enough in repealing the ACA, while moderates, including Senator Susan Collins (R-ME), asserted that the Medicaid cuts would hurt many in her state.

As anticipated, the CBO estimate released earlier this week made obtaining majority support for the bill much more difficult.  Despite several modifications, the measure’s projected impact on the health care system was very similar to the House bill.  According to CBO, 22 million individuals would no longer have health care coverage if the BCRA were enacted into law, including 15 million individuals on Medicaid.  Furthermore, the federal contribution to Medicaid via a per-capita-cap would gradually decrease to 26 percent by the end of the ten-year budget window and escalate even more after that time.

As conveyed by CSAC and other key stakeholders to the California congressional delegation, the ACA has been used to enroll 3.7 million new residents in the Medi-Cal program.  Additionally, the ACA’s Medicaid expansion has enabled the state to drive its uninsured rate from over 20 percent to lower than 7 percent.  The State of California’s initial estimates project a loss of $30 billion annually when factoring in a Medicaid expansion repeal and the imposition of a per-capita-cap.

Please click here for an analysis of the impact the Senate Health Care Bill could have on California. 

In the immediate aftermath of the release of the CBO score, additional senators announced their opposition to the bill while others indicated that they would need more time to analyze the impact on their home states. Facing certain defeat, Majority Leader McConnell announced on June 27 that there would be no vote on the ACA repeal bill before the July 4 recess.  At press time, it was announced that GOP leaders have agreed to add $45 billion worth of funding to help combat the Opioid crisis, though it remained unclear if the addition of the funds would win over any Republicans holdouts.

Looking ahead, Republican senators will continue to meet in an attempt to craft a bill that would receive at least 50 votes (Vice-President Pence could supply the tie-breaking vote, if necessary).  The balancing act of finding a compromise bill that attracts enough conservative Republicans and/or moderates remains a daunting task for the GOP leadership.