Crystal Ball on the Senate Bill 

The US Senate may be on recess this week, but their health reform bill is still in the news as some Republican senators face opposition at home and others hash out possible changes to the bill in hopes of garnering enough votes for passage. President Trump is doing his part to keep things interesting with a tweet calling for “Repeal now, replace later.” Although the latest reporting suggests a vote next week is highly unlikely, we thought we would share our view of where things currently stand. 

• Repeal now, replace later: “Not happening” is the word from inside the Beltway. Repealing the ACA without a replacement program is a tough political move because it would leave so many uninsured. As a reminder, a CBO report in 2015 projected a repeal bill would have resulted in 32 million losing coverage. The House might be able to pass a repeal-only bill, but it is unlikely that Senate Republicans would be able to get 50 votes, especially given their negative reaction to the increase in uninsured associated with the current CBO score of the BCRA. Further complicating this approach is that only certain parts of the ACA can be repealed under reconciliation with no promise of what the “replace” would be.

• If Senate is able to pass some version of BCRA: Odds for enactment would increase substantially. A Senate-passed bill would probably be sent to the House with a “take it or leave it” message and the clock ticking. The betting is that while House conservatives would grumble, they’d vote for it.

• Practical deadline: End of July, when Republicans want the debate and vote to be completed.

• Hard deadline: End of September, which is the end of the current fiscal year when current reconciliation “instructions” expire.

• Latest wildcard that could impact timing:  Senators Ted Cruz and Mike Lee are promoting their proposal  to require insurers to sell at least one plan that meets ACA regulations but also allow them to sell policies that don’t. This way, insurers could offer cheaper, less-comprehensive policies that would be attractive to healthier people. People with pre-existing medical conditions could be charged more for these non-ACA-compliant policies, and possibly denied this coverage altogether. It’s not clear what the Senate will decide to do with this new proposal, but – as employer plan sponsors know all too well – splitting the risk pool like this creates risk selection issues, and it could mean a quick death spiral for the plan that meets ACA requirements.   

The fate of the BCRA may rest with the CBO scoring of last week’s additions to the bill and the Cruz/Lee amendment. We will continue to cover and provide updates.