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This page last updated on July 28th, 2017.

As you probably know, in the early hours of July 28th the Senate voted “no” on legislation to repeal the Affordable Care Act (ACA). While this vote is a huge win for patients in a process that has been fraught with uncertainty, it does not mark the end of health reform efforts or our community’s need to diligently make our voice heard!

ACA repeal efforts had moved to the Senate following the House’s passage of an ACA repeal bill in May. During a 20-hour debate, the Senate brought up, but failed to pass, a number of different options. The first Senate bill would have repealed the ACA’s patient protections and made deep cuts to Medicaid. A subsequent Senate bill sought the outright repeal of all budget-related provisions of the ACA, but that too, went down to defeat.

Finally, at 10:00 last night, the Senate leadership unveiled an 8-page “skinny bill” to repeal the ACA’s individual and employer mandates. The leadership’s strategy was to get 50 votes in favor of any bill, and then produce a better bill once in conference with the House.

The CBO estimated that enactment of the “skinny bill” would lead to 16 million people losing insurance, much higher premiums for those still covered, and the breakdown of the US private insurance market. For all these reasons, the bill was opposed by governors from both political parties, patient groups, medical providers, and the insurance industry. In the end, 3 Republicans (Sens. Collins, Murkowski, and McCain) decided that they could not risk voting for the bill. Their votes, combined with the votes of 48 Democratic Senators, assured the bill’s defeat at 2:00 a.m. on July 28th.

We cannot promise you that the defeat of the Senate bill marks the end of health reform efforts in Washington. There are budget bills still pending, administrative actions that will affect the insurance markets, and fixes that are needed for the ACA. But here are two key takeaways from the past 6 months’ efforts. First, if the intended outcome of reform is better, more affordable health care and insurance for all, none of these bills would have accomplished that. None of them would have lowered premiums or out-of-pocket spending for comparable coverage and all of them threatened our community’s ability to access coverage and care. Second, the bills were defeated due to mobilized grassroots activism. Your voice made a real difference at a critical time! 


Explanation of the Better Care Reconciliation Act (BCRA)

  • The most recent version of the BCRA included money for the opioid crisis and the so-called “Cruz Amendment” – which would allow insurance companies to sell plans that don’t cover n essential health benefits as long as they also sell one plan that complies with federal regulations. Many health policy experts, as well as the insurance industry, came out strongly against the Cruz amendment, stating that it would make comprehensive health plans unaffordable.
  • This version of the BCRA still undermines protections for those with pre-existing conditions by allowing states to waive basic coverage standards: prescription drugs, hospitalization, specialty care, etc. Insurance companies would still have to sell policies to all applicants, but those policies could exclude important benefits and/or treatments for certain conditions from coverage. “Pre-existing conditions” protections would be meaningless, since insurance companies could simply decline to cover expensive conditions or treatments.
  • On July 20th, the Congressional Budget Office (CBO) released the score of the newest version of the BCRA (NOT including an analysis of Cruz Amendment – which will come later this week) and found that by 2018, 15 million more Americans would be uninsured than under current law, with that number rising to 19 million in 2020 and 22 million in 2026.
  • The report also indicated that certain provisions of BCRA would lead to an increase in deductibles that would eventually become so high (an estimated 1525% increase by 2026), that BCRA compliant plans would start to violate out-of-pocket spending limits.

Explanation of the Obamacare Repeal Reconciliation Act (ORRA):

  • The CBO estimates that ORRA would result in 17 million more Americans uninsured than current law by 2018 and 59 million more uninsured by 2026.
  • Health policy experts warn that enacting a “repeal and delay” bill would cause chaos in the US insurance markets. Because this strategy allows for repeal of only the ACA’s budget-related provisions, the ACA’s insurance market regulations would remain in place (pre-existing conditions protection, essential health benefits, coverage of kids to 26, etc.). However, the ACA’s individual and employer mandates would disappear, as would the subsidies that make insurance affordable. Employers would face no penalty if they chose to stop providing insurance to their workers. Insurers would operate in a market that requires them to sell plans to those with pre-existing conditions, but lacks the incentives necessary for healthy, young people to purchase plans and balance out their risk pools.
  • In a best-case scenario, under repeal and delay, insurers would stay in the market but premiums would soar. The worst-case scenario is that insurers would stop selling insurance immediately, fearing the instability of a market that would disappear under new regulations in two years. Many fear that under this plan, the non-group market would collapse in short order and Medicaid would not be able to make up for the loss of private insurance options, as the bill would terminate the ACA’s Medicaid expansion.



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