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Senate Postpones Vote on Health Bill

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Senate Republican leaders announced today in Washington that they are giving up on trying to get the Better Care Reconciliation Act bill to the Senate floor for a vote this week.

Senate Majority Leader Mitch McConnell said at a press conference, which was streamed live on C-SPAN, that Senate Republicans need more time to talk about the bill.

“We’re still optimistic we’re going to get there and get a result better than the status quo,” McConnell said.

(Related: Senate Bill Could Add 22 Million to 2026 Uninsured Total: CBO)

President Donald Trump has invited Senate Republicans to a meeting on the BCRA bill at 4 p.m. today, McConnell said.

“He wanted to talk to us all together today,” McConnell said.

In the past few weeks, “the White House has been very much involved” in discussions about the bill, McConnell said. “We hope members over there.”

The BCRA Bill

The BCRA bill is the Senate’s version of H.R. 1628. Members of the House passed another version of H.R. 1628, the American Health Care Act bill, by a 217-213 vote, May 4.

Both the Senate BCRA bill and the House AHCA bill would replace the current Affordable Care Act public exchange plan premium tax credit system, repeal Affordable Care Act penalties and taxes, and give states a mechanism they could use to waive some Affordable Care Act health insurance rules.

Both versions would also replace Affordable Care Act health insurance market stabilization funding programs with new state grant programs.

The Legislative Process

Sen. John Barrasso, R-Wyo., who also spoke at the press conference, said the Senate needs to make health system changes quickly.

“The pain of Obamacare continues to get worse,” Barrasso said.

McConnell noted that Democrats faced delays when they were working to pass the bills that created the Affordable Care Act, in 2009 and 2010. He said he thinks Republican senators simply need more time.

“This is a big, complicated subject,” McConnell said.

Senate supporters of the BCRA bill have faced skepticism from the right, from senators such as Rand Paul, R-Ky., who say the bill would leave too much of the current Affordable Care Act system in place.

The BCRA bill also faces resistance from centrist Republican senators, such as Susan Collins of Maine and Dean Heller of Nevada who say the bill could leave too many people with no access to affordable health coverage.

Bill supporters now appear to have too few votes to bring the BCRA bill up for debate on the Senate floor.

CBO Predictions

The Congressional Budget Office announced Monday that it believes the BCRA bill could leave a total of 49 million people without health coverage in 2026.

About 26 million people are uninsured today.

CBO analysts predict that about 27 million people could be uninsured in 2026 if the current Affordable Care Rules stay in place.

The number of uninsured people could increase by 22 million, to 49 million, if the BCRA bill becomes law, according to the CBO.

Health Insurers

Health insurers and their actuaries now face even more uncertainty about how to develop individual and small-group products for 2018.

The BCRA bill, for example, could eliminate the individual coverage mandate and other provisions that now help to hold down premiums, by pushing young, healthy to pay for premiums even when they have no obvious, immediate need for medical care.

The BCRA bill would provide funding for programs that help keep individual coverage affordable, such as a cost-sharing reduction subsidy program that helps pay the deductibles for low-income exchange plan users. If the bill fails, however, it’s not clear whether the Trump administration would continue to make cost-sharing reduction subsidy program payments.

Under federal rules, health insurers in many states that use for Affordable Care Act exchange administration were supposed to file 2018 product descriptions and rates by June 21.

Regulators in some states have already said they will let insurers change their filings for 2018 to reflect sudden, drastic changes in the 2018 rules.

Iowa has proposed developing a government-run program that would be similar to a premium-supported managed Medicaid program to provide individual coverage for its residents in 2018.

Dave Dillon, an actuary, said in an interview in April that, if regulators responded to the prolonged regulatory uncertainty by easing major medical rules temporarily for 2018, insurers could probably get 2018 health coverage products of some kind to market very quickly.

— Check out 5 Things for Agents to Know About the Senate Health Bill on ThinkAdvisor.


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