ACA Watch September 21, 2017
Surprise! After several ACA repeal-and-replace bills did not succeed earlier in the year (including the Skinny repeal bill,) ACA repeal now has a real chance of passing by the end of this month.
“Before the clock strikes midnight”
The Senate has up until midnight the evening of September 30th to pass a repeal-and-replace bill using the budget reconciliation process. Under the budget reconciliation method, legislation is easier to pass because it does not allow filibuster and would need only a simple majority (51 votes) in the Senate.
With their newest Graham-Cassidy bill, GOP Congress members make a final effort to repeal and replace the ACA before the September 30 deadline hits. Authors of the bill, Senators Bill Cassidy (R-LA) and Lindsey Graham (R-SC) are working to garner support from fellow Senators before a vote next week.
The September deadline puts an “extreme” time crunch on lawmakers, especially by Senate standards (CNN.)
President Trump and Vice President Pence stated their firm support for the Graham Cassidy bill, and have been calling senators and governors to garner their support. Mike Pence has publicly stated that Trump will sign the bill if it is passed in the Senate. The Trump administration has made it clear that they support repeal only and do not support fixing the ACA. This appears to eliminate any bipartisan efforts towards bills stabilizing ACA insurance markets (The Hill.)
What’s in the Graham-Cassidy Bill?
The Graham Cassidy Bill would change the ACA in the following ways:
- Convert federal payments for the ACA’s Medicaid expansion and marketplace subsidies into Medicaid Block Grants
- Allow States the flexibility to define their own “essential health benefits”
- Remove penalties for employer and individual mandate (Lockton)
- Repeal some taxes imposed by the ACA, including the tax on over-the-counter medications
- Improved capabilities of tax-advantaged Health Savings Accounts (HSAs) (Senate website)
- Reduce tax for non-qualified expenses to 10%
- Allows insurance premiums to be paid by HSA in 2018
- Allows use of HSA to for qualified medical expenses for account holder’s children under age 27 in 2018
- Allows use of HSA for primary care service
- Increase HSA maximum contribution limit to match HDHP out-of-pocket
- Special rule qualifying expenses that occurred before HSA was established
The bill is similar to the previous GOP repeal bill, the Better Care Reconciliation Act.
CBO Score expected this week
Adding to the complexity of the situation, no Congressional Budget Office (CBO) score has been issued for the Graham-Cassidy bill thus far. The CBO anticipates delivering the score this week. (Lockton)
The nonpartisan CBO issues a score for each bill. The CBO score assesses the bill’s impact on federal spending, premium costs, and health coverage levels. If the score is issued this week, the Senate would be able to utilize the last week of September to bring the GOP bill to a vote.
Yes, no, and undecided
The yet-to-be-announced CBO score along with the rushed timeline for reviewing the bill leaves some Senators with a hasty decision to make.
The three Republican senators who voted against the last GOP ACA repeal bill in July; Senators McCain (AZ), Collins (ME), and Murkowski (AK); are all undecided on the bill thus far. All three declined to state publicly whether they will vote for or against the Graham-Cassidy bill. It is likely that votes from these Senators will be a deciding factor in the ultimate fate of the legislation.
Rand Paul, (R-KY) stated that he will vote no. All Democrats are all expected to vote no, as well.
According to the Hill, ten Republican Senators say that they will vote yes, and three more of them say they will “likely” vote yes. The “yes” votes include Senate Majority Leader Mitch McConnell (R-KY), who has endorsed his support. The rest are undecided.
House Speaker Paul Ryan (R-WI) applauded the bill via Twitter; though, he stopped short of endorsing the bill.
Some Senators still considering the bill expressed that they need to assess the impact on their state. The Graham-Cassidy bill’s block grants shift some power given to the states. It will also impact state Medicaid programs and the opioid crisis.
A vote in the Senate could come in the final week of September 2017. In the event of a 50-50 tie, Vice President Mike Pence could break the tie by casting his vote along with fellow Republicans (Lockton).
After September 30 the bill will need 60 votes to pass instead of 51. This would likely require support from Democrats (The Hill.)
As a long-time member of the Employers Council for Flexible Compensation (ECFC), Employee Benefits Corporation will continue to provide ACA Watch updates as legislation continues to evolve.