Senate Republican leadership continue to meet to craft their bill to fix the Affordable Care Act. Discussions are focused on provisions to end the additional federal funds for Medicaid expansion, moderates recommending a seven-year phase-out while leadership is recommending three years. Senate leaders support allowing states to be exempt from the ACA rules on what an insurance plan must cover, known as essential health benefits, but not from the rules preventing people with pre-existing conditions from being charged more, known as community rating. Most recently, the Senate Parliamentarian has warned that a provision preventing tax credits from being used on insurance plans that cover abortion is unlikely to be allowed under Senate rules. If that provision is not allowed, the bill may lose conservative support. The Senate needs 51 votes to pass the legislation, so negotiations among Republican Senators are ongoing. A bill draft is expected to be released June 22, then scored by the Congressional Budget Office before taken to the floor before July 4 recess.

 

House Republican leaders worked closely with the White House to propose additional amendments to H.R. 1628 in order to secure the necessary Republican votes to move the bill forward. North Carolina Republican Representatives George Holding (R-2), Virginia Foxx (R-5), Mark Walker (R-6), David Rouzer (R-7), Richard Hudson (R-8), R obert Pittenger (R-9), Patrick McHenry (R-10), Mark Meadows (R-11), and Ted Budd (R-13) voted for the bill. Representative Walter Jones (R-3) joined Democrat Representatives G.K. Butterfield (D-1), David Price (D-4), and Alma Adams (D-12) to oppose the measure. The Congressional Budget Office scored the House bill after the floor vote and estimated the measure would increase the number of uninsured by 23 million by 2026.

 

Meanwhile, insurance companies want assurances that they will continue to receive cost-sharing reduction payments from the federal government, estimated to be about $7 billion this year, to subsidize out-of-pocket costs for lower-income households. Insurers are facing imminent deadlines in many states to submit their preliminary premium requests and state whether they will stay in the market. In addition, they also face a June deadline to tell the federal government whether they will participate next year. Some states are considering their own reinsurance program to keep companies engaged. Some are offering tax relief to operate in rural counties. Press reports state that Blue Cross and Blue Shield of NC is seeking an average rate hike of almost 23 percent because of the uncertainty around the cost-sharing payments vs. rate increases of less than 9 percent otherwise.   

 

Should the Senate produce something significantly different from the House bill, the President and congressional leaders will face the choice of trying to reconcile the House and Senate versions or trying to jam the Senate bill through the House. There is still no guarantee of final passage of a health care bill to revise the Affordable Care Act.