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July 5, 2017

New GOP proposal may allow far more plans that don't cover essential health benefits

Daily Briefing

Republican Senate leaders over the holiday weekend asked the Congressional Budget Office (CBO) to score an updated version of their health reform bill, which may allow more insurance plans that do not cover the Affordable Care Act's (ACA) essential benefits, but lawmakers do not appear to have reached a consensus around a proposal among rank-and-file Republicans. 

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Senate Majority Leader Mitch McConnell (R-Ky.) had hoped to reach a consensus on changes to the Better Care Reconciliation Act (BCRA) by Friday so lawmakers could send the revised bill to the CBO to score over Congress' July 4 recess and hold a vote shortly after lawmakers reconvene on July 10.

However, in news appearances over the weekend, Republican senators suggested they are still at odds. Sen. Rand Paul (R-Ky.) told "Fox News Sunday," that GOP senators were "at an impasse."

Sens. send CBO revised bill

Senate Republicans have asked CBO to score a proposed amendment by Sens. Ted Cruz (R-Texas) and Mike Lee (R-Ariz.) that insurance experts say could create "a sort of de facto high risk pool," the New York Times' "The Upshot" reports. Cruz has yet to publicly release legislative language for the proposal, which is being circulated on handouts. 

According to those handouts and Cruz's comments, the proposal would allow insurers that offer at least one health plan that complies with all of the ACA's rules, including its essential health benefits requirements and its provision barring insurers from charging individuals with pre-existing conditions more for coverage, to also sell lower-cost plans that do not meet the ACA's requirements. The proposal could potentially allow insurers to avoid meeting the ACA's pre-existing coverage protections in some offerings, Axios reports. 

Individuals up to a certain income would be eligible for federal subsidies to help purchase the ACA compliant plans, while those who select the non-compliant plans would be allowed to use health savings accounts to help purchase coverage, "The Upshot" reports.

Cruz on Thursday said the Senate parliamentarian had not raised concerns with his proposal, CQ HealthBeat reports. However, some insurance experts say the proposal could result in a segmented market, with healthy individuals purchasing the less comprehensive lower-cost plans and sicker individuals purchasing the costlier, ACA compliant plans.

Sabrina Corlette, a director at the Center on Health Insurance Reforms at Georgetown University, said, "If you're unsubsidized, and you can't find an underwritten plan, you're stuck being uninsured or paying exorbitant premiums." She also noted that the proposal could discourage insurers from strongly marketing their non-compliant plans since they are more likely to attract sicker customers.   

Senate Republicans also asked CBO to score a version of BCRA without the proposed amendment to better determine how the change would affect premium rates and federal subsidies, Axios reports.

According to The Hill, the proposal could strike a compromise between moderate Republican senators who want to maintain some of the ACA's coverage protections and conservative members who say the bill in its current form does not go far enough to repeal and replace the ACA. However, a senior GOP aide said that the potential for insurers to exclude individuals with pre-existing conditions in non-compliant plans would be a non-starter for about 20 to 30 senators, Axios reports.

White House legislative affairs director Marc Short in an appearance on "Fox News Sunday," suggested the Trump administration supports the proposed amendment, saying, "We hope it's part of the process of bringing everybody together."

Some conservatives open to Trump's call for repeal with delayed replace

Despite initial push back from GOP senators, several conservative members over the weekend suggested they were open to President Trump's call on Friday to repeal the ACA and replace it at a later time.

Trump in a tweet Friday said, "If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!"

The proposal, which House Republicans considered and ultimately dismissed during negotiations over their bill to repeal and replace the ACA, has support from Paul and Sen. Ben Sasse (R-Neb.), the Washington Post's "The Fix" reports.

Lee in a Sunday appearance on CBS' "Face The Nation" said, "If we can't get this done ... what we ought to do is ... push full repeal and then embark on an iterative step-by-step process to decide what comes next"

(Greenwood, The Hill, 7/1; Nather, Axios, 7/2; Owens, Axios, 6/29; Owens, Axios, 7/1;  Rappleye, Becker's Hospital Review, 6/30; Diamond, "Pulse," Politico Pro, 7/5 [subscription required]; Ellen McIntire [1], CQ HealthBeat, 6/30 [Subscription required]; Ellen McIntire [2], CQ HealthBeat, 6/30 [Subscription required]; Blake, "The Fix," Washington Post, 6/30; Savransky, The Hill, 7/2; Sanger-Katz, "The Upshot," New York Times, 7/5).

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