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July 12, 2017

What we know (and don't know) about the revised Senate health care bill

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Senate Majority Leader Mitch McConnell (R-Ky.) Tuesday said he plans on Thursday to release an updated version of the Senate GOP's health reform legislation, called the Better Care Reconciliation Act (BCRA).

New: 3 steps to establishing an intentional Medicare risk strategy

To ensure the Senate has enough time to act on the revised legislation, McConnell said the Senate will delay the start of its August recess, which had been scheduled to begin at the end of this month, until the third week of August. McConnell said the Senate also will tackle other legislative priorities during their extended time in session.

According to Politico, Republicans leaders in the House have not announced a similar delay, though they might face pressure to do so.

What's in the revised bill?

The revised bill is expected to largely reflect the proposals originally included in BCRA, such as the bill's proposed changes to Medicaid, The Hill reports. However, various GOP lawmakers and aides who were briefed on the updated legislation said it will keep in place two of the Affordable Care Act's (ACA) taxes:

  • A 3.8 percent tax on investment income for individuals with an annual income of at least $200,000; and
  • A 0.9 percent Medicare payroll tax on high-income individuals' wages and self-employment income.

According to the Washington Post's "PowerPost," Republicans said keeping those taxes in place for between five and seven years could allow the federal government to contribute more money to a fund intended to help offset U.S. residents' health care costs.

The revised bill also likely will include $45 billion in funding to help states address the U.S. opioid misuse epidemic and a provision that would allow U.S. residents to use heath savings accounts to pay for their health plan premiums, according to the New York Times.

The Hill reports that Republican senators also will receive a separate revised version of BCRA that includes an amendment proposed by GOP Sens. Ted Cruz (Texas) and Mike Lee (Ariz.). The amendment 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. Some moderate Republicans have expressed concerns about how the amendment could affect premiums for individuals with pre-existing conditions, but a Republican senator familiar with discussions on the amendment said negotiators are looking at ways to address those concerns, The Hill reports.

According to The Hill, Senate GOP leaders have submitted both versions of the revised legislation to the Congressional Budget Office (CBO) for a score. According to NPR, scores of the revised legislation likely will be released Monday or Tuesday, and the Senate could hold a motion to proceed on the legislation by the end of next week. It is not clear which version of the bill McConnell will decide to bring to the Senate floor for a vote, The Hill reports.

However, Axios' "Vitals" reports that the Senate parliamentarian still must decide whether the amendment offered by Cruz and Lee complies with rules to advance the legislation under the budget reconciliation process. If the amendment does not meet those rules, it likely will not be included in BCRA, "Vitals" reports.

Sen. Graham says he is working on an alternative proposal

In related news, Sen. Lindsey Graham (R-S.C.) on Tuesday said he is drafting an alternative health reform plan, The Hill reports.

Graham said, "I'm working with some senators to come up with a new approach to deal with how to replace Obamacare." He added, "I think it will be fundamentally different. I think it will potentially attract some Democrats."

Graham spokesperson Kevin Bishop said the proposal will be in the form on an amendment that could be added to BCRA. Bishop did not say whether the amendment could serve as a replacement for BCRA.

According to Politico, Graham on Tuesday said he would unveil the proposal within "24 to 48 hours" (Taylor, NPR, 7/11; Bolton, The Hill, 7/11; Snell et al., "PowerPost," Washington Post, 7/11; Kaplan/Pear, New York Times, 7/11; Nather/Baker, "Vitals," Axios, 7/12; Min Kim/Everett, Politico, 7/11; Sullivan, The Hill, 7/11; Owens, Axios, 7/11; Wright, Politico, 7/11).

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