The Senate Thursday released its long-awaited health reform draft bill, but GOP senators say more changes will be needed to secure the 50 votes needed to pass the bill in the Senate.
See how the ACA compares with the House and Senate health bills
The three big roadblocks in the bill's future
Senate Majority leader Mitch McConnell (R-Ky.) reportedly still plans to bring the bill to floor for a vote before the July 4 recess.
However, Senate Republicans face three main roadblocks to bringing the bill to a vote:
- Senate must wait to vote until it has an official CBO score, which is expected to come as early as next week;
- The Senate Parliamentarian has yet to rule on whether specific measures—such as those related to the age-band restrictions, the ACA's 1332 waivers, and abortion—meet requirements to be considered under the reconciliation process; and
- It does not appear that McConnell has secured the 50 votes necessary to pass the bill.
Conservative GOP Sens. Ted Cruz (Texas), Mike Lee (Utah), Ron Johnson (Wis.), and Rand Paul (Ky.) in a statement said they do not support the bill in its current form, but "are open to negotiation and obtaining more information before it is brought to the floor." Paul separately said the draft bill contains too many ACA regulations and maintains the law's structure for tax credits.
Some moderate senators, such as Sen. Susan Collins (R-Maine), also expressed concerns with the bill. Nather Baker in Axios' "Vitals" wrote some key sticking points for moderates could include the significant Medicaid cuts and low funding for opioid misuse programs. The Senate draft bill in 2018 would provide $2 billion for opioid misuse efforts, but Sens. Rob Portman (R-Ohio) and Shelley Moore Capito (R-W. Va.) have reportedly asked for $45 billion over a decade.
However, Vox's Dylan Scott suggests that McConnell purposefully crafted a draft bill that would "give both his conservative and his moderate senators some wins and some losses," adding, "If senators decide that the most important thing to them is saying they repealed Obamacare, there is a path to yes for all of them."
As Sen. John Thune (R-S.D.) told reporters Thursday, "There are some things we've said all along that are dialable, that we can hopefully tweak a little bit before it comes to the floor" (Scott, Vox, 6/22; Garfield/Damico, Kaiser Family Foundation, 10/19/16; Nather/Baker, "Vitals," Axios, 6/23; Johnson, "Wonkblog," Washington Post, 6/22).
Be prepared for any ACA scenario: Get the new Clinical Leader's Resource Guide
Clinical leaders at every level should be preparing for a world in which insurance may be less generous, patients will act more like consumers, hospitals will face tighter margins, and workloads will be heavier and more complex.
To help you and your clinical teams operate in this uncertain time, we've created The Clinical Leader's Resource Guide. Inside you'll find the information and no-regrets strategies needed to support clinical outcomes and financial success in any regulatory environment.