After weeks of secrecy and speculation, Senate Republicans have finally unveiled a 142-page iteration of their health-care bill, titled the “Better Care Reconciliation Act of 2017.” Written by a group of 13 GOP Senators headed up by Majority Leader Mitch McConnell, the “discussion draft” largely resembles the 131-page American Health Care Act, passed by the House of Representatives last month.
Like the AHCA, the Better Care Reconciliation Act would repeal the Affordable Care Act’s individual and employer mandates as well as nix a bevy of ACA taxes, including those on tanning, over-the-counter medications, flexible spending accounts (FSAs), and health savings accounts (HSAs), as well as the “Cadillac tax” and others. The bill would also eliminate the $2,500 limit the ACA placed on FSAs, giving more leeway to a growing market for concierge care.
Most notably, the Better Care Reconciliation Act would defund Planned Parenthood for one year and restrict subsidies for insurance plans covering abortion in cases not involving rape, incest, or saving the mother’s life. Reports previewing these stipulations were hotly contested prior to the bill’s reveal and may put its passage in jeopardy, as Republican senators Lisa Murkowski and Susan Collins hinted that they would not vote for a bill defunding Planned Parenthood. However, because the bill was written as a reconciliation act, it will require the votes of only 50 senators plus Vice President Pence to pass, as Democrats cannot filibuster it.
The Senate’s proposed subsidies for low-income Americans buying insurance on the individual market are more generous than those delineated by the AHCA. The Better Care Reconciliation Act allots a $50 billion Obamacare bailout to the states over the next four years — $15 billion annually in 2018 and 2019, and $10 billion annually in 2020 and 2021 — to stabilize their insurance markets. The bill prescribes a three-year transition period, beginning in 2021, to gradually end the ACA’s Medicaid expansion. After that point, the states would also take over the primary burden of stabilizing the insurance market. The bill would largely maintain the ACHA’s block-grant funding for Medicaid.
In contrast to the House’s AHCA, the Senate bill barely modifies Obamacare’s income-adjusted tax credits, reducing the law’s eligibility threshold from 400 percent of the federal poverty line to 350 percent. The Senate bill does, however, make some significant (though piecemeal) repeals of ACA funding for preventative and public-health measures. To compensate, it appropriates $2 billion in extra funding for the opioid crisis and other drug-abuse and psychiatric-care programs.
McConnell wants to bring the bill to a vote before the Senate’s recess for the Fourth of July. Without the votes of Murkowski and Collins, the Republicans would have the exact number of votes necessary to pass the bill, though Senator Rand Paul has expressed frustration with the bill’s secrecy, proposing a “Read the Bills” resolution to institute a mandatory waiting period before voting. Paul has previously stated that he would frown on an AHCA that increased subsidies to insurance companies.
More-conservative wings of the Senate may be won over by the expansion of “1332” waivers, which allow for more state flexibility, but the bill maintains Obamacare’s rules regarding preexisting conditions, raising the question of the “death spiral,” in which premiums spike as a result of removing the individual mandate and making risk pools more expensive.
Senate Majority Whip John Cornyn will have only eight days to secure the bill’s passage in time for the Senate’s recess. This may come down literally to a 50–50 shot.
— Tiana Lowe is an editorial intern at National Review.