Top takeaways from the week: (1) Senate Republicans remain at an impasse regarding their stalled ACA repeal plan, (2) Republicans released an updated repeal-only bill, the Obamacare Repeal Reconciliation Act (ORRA), modeled after the 2015 Reconciliation bill, (3) the Congressional Budget Office (CBO) released two sets of projections based on the ORRA and the most recent version of the Better Care Reconciliation Act (BCRA), and (4) Leadership is still planning to hold a vote to begin debate on BCRA early next week.

Despite the ongoing uncertainty and chaos surrounding Senate Republican’s plan to repeal and replace the ACA, as of today, Senate Leadership is planning to hold a vote on a motion to begin debate on the Better Care Reconciliation Act (BCRA), early next week.

Reflecting on the turmoil of the past week, Senate HELP Committee Chair Alexander (R-TN) noted today that “The math has always been difficult but there’s a feeling that we have a responsibility to get to a result. And we’ve worked for a long time to get one and we’re still trying.”

Senate Action –

Senate leadership had initially hoped to schedule a vote on the bill this week, but on Saturday announced a decision to postpone the vote indefinitely, following news that Sen. McCain (R-AZ) had undergone surgery and would need time to recover.

Then on Monday evening, Sens. Lee (R-UT) and Moran (R-KS) announced their intention to vote against a motion to proceed on the BCRA, arguing that the current version of the bill does not go far enough in repealing the ACA. Given that Sens. Paul (R-KY) and Collins (R-ME) had previously announced their objection to moving forward on the bill, Senate Majority Leader McConnell (R-KY) then issued a statement announcing that “the effort to repeal and immediately replace the failure of Obamacare will not be successful” and announcing that the Senate would instead take up a version of the original 2015 ACA repeal bill that was vetoed by former President Obama in February 2016. Press releases: and and

Following Majority Leader McConnell’s announcement to advance a clean repeal bill, the Senate Budget Committee released the Obamacare Repeal Reconciliation Act (ORRA) which would repeal – with a two-year delay in effective date – provisions including the individual and employer mandates, the ACA’s taxes, and Medicaid expansion, but would also allocate $750 million for each of fiscal years 2018 and 2019 to states for substance abuse and mental health needs. CBO also released an analysis of the bill, finding that it would decrease the federal deficit by $473 billion over ten years but would result in 32 million more uninsured people in 2026. ORRA Summary: Bill text: CBO Analysis:

However, on Tuesday at least three Republicans – Sens. Capito (R-WV), Collins (R-ME), and Murkowski (R-AK) announced that they would oppose a straight repeal without the assurance of a replacement plan. Sen. Capito noted in a statement that “I did not come to Washington to hurt people…I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.” Press releases: and and

By mid-afternoon on Tuesday, Majority Leader McConnell held a press conference in which he noted his intent to continue with a motion to proceed, but hinted at the potential need for a bipartisan solution, nothing that after the vote, “we will have demonstrated that Republicans by themselves are not prepared at this particular point to do a replacement and that doesn’t mean the problems all go away. You’ll have to look at our committee Chairmen and their Ranking Members.” He also added “my suspicion is there will be hearings about the crisis that we have we’ll have to see what the way forward is.”

However yesterday, President Trump summoned Senate Republicans to a lunch at the White House, where he urged them to work together to pass repeal and replace legislation, arguing that they should not leave for their summer recess until they have worked out an agreement. After the lunch, Senate Majority Leader McConnell affirmed, “Next week we’ll be voting on the motion to proceed, and I have every expectation that we’ll be able to get on the bill.”

In an effort to take advantage of the momentum from their meeting at the White House, last night at least 20 Senate Republicans – including key holdouts as well as supporters of the bill – met for more than three hours hoping to resolve their differences and to revive efforts to save the BCRA. The group discussed Medicaid, coverage numbers, lowering premiums and cutting regulations, but did not emerge with a consensus on a path forward.

Today, the Senate Budget Committee released updated text for the BCRA, which makes technical adjustments to the language. The updated bill also removes language related to Sen. Cruz’s ‘Consumer Freedom’ amendment, which would have allowed issuers to offer plans that do not comply with ACA’s protections, as long as they also offer a fully compliant plan. Press release:  Section-by-section: Updated BCRA text:

CBO subsequently published an analysis of the updated BCRA bill (without the Consumer Freedom amendment), finding that the legislation would reduce federal deficits by $420 billion over the next ten years and would increase the number of uninsured people by 22 million in 2026. CBO’s previous analysis of the June 26 version of the BCRA also projected 22 million more uninsured, but $321 billion in deficit savings. The additional projected deficit savings found in the updated bill may provide Senate leadership with more funding for towards market stabilization efforts or lessening the impact of Medicaid cuts in an effort to sway holdout Senators. CBO Analysis:

Sen. Cruz (R-TX) released his own analysis yesterday that was developed by HHS on the ‘Consumer Freedom’ amendment, which finds that the amendment would expand coverage by more than two million individuals and would reduce premiums by more than $7000 per year, as compared to current law. Sen. Cruz Press release:  Summary: Report:

Meanwhile, there have been growing calls this week from Senators and stakeholders on both sides of the aisle for the Senate to take time to hold hearings or to work in a bipartisan way to address the insurance markets.

On Monday, in a letter to Majority Leader McConnell (R-KY) and Chairmen of the Senate HELP and Finance committees on Monday, Minority Leader Schumer (D-NY), and Ranking Members Murray (D-WA) and Wyden (D-OR) asked Republicans to use the delay in the vote to invite representatives of major healthcare and patient advocacy groups to speak at public hearings on BCRA. Press release:

Sen. McCain’s office released a statement on Monday also urging Congress to “return to regular order, hold hearings, receive input from members of both parties, and heed the recommendations of our nation’s governors so that we can produce a bill that finally provides Americans with access to quality and affordable health care.” Press release:

Senate HELP Committee Chair Alexander (R-TN) argued on Tuesday that his committee “has a responsibility during the next few weeks to hold hearings to continue exploring how to stabilize the individual market.” He further noted his intention to consult with Senate leadership and set hearings after the Senate votes on the repeal bill. Press release: and

Additionally, Sens. Manchin (D-WV) and Rounds (R-SD) led a bipartisan group of former Governors in a meeting on Tuesday night to discuss a bipartisan path forward on healthcare. Sen. Carper (D-DE) noted afterwards that “There was a general agreement around the need to return tor regular order. There was also a realization that for most of us the exchanges can be stabilized, need to be stabilized.”

Lastly, a group of 11 bipartisan governors issued a statement Tuesday urging that the Senate “should immediately reject efforts to ‘repeal’ the current system and replace sometime later.” The statement supports the idea that both parties should come together to “fix the unstable insurance markets.” Press release:

Administrative Action –

Although the White House has not committed to continuing cost-sharing reduction payments, the Administration made its July payments to issuers yesterday. The White House confirmed that it had made the payments despite a pledge this week from President Trump to “just let Obamacare fail.” Yesterday, President Trump commented on the importance of CSRs for market stability, noting that “we pay hundreds of millions of dollars a month in subsidy that the courts don’t even want us to pay. And when those payment stop, it stops immediately. It doesn’t take two year, three years, or one year – it stops immediately.”

Meanwhile, yesterday New Hampshire announced a section 1332 waiver proposal, which would establish a new state-based reinsurance program. Proposal:

House Action –

The House Budget Committee released its fiscal year 2018 Budget Resolution on Tuesday, which assumes all of the policies in the House-passed repeal bill, the American Health Care Act, will become law. It also implements Republican proposals for Medicare premium support, leading to savings of $487 billion over 10 years. In total, proposed changes to Medicaid and other health programs would result in $1.5 trillion in savings over 10 years. Budget Resolution:

Also on Tuesday, Rep. Biggs (R-AZ) introduced three bills that would repeal the ACA and stabilize the marketplaces: the Responsible Path to Full Obamacare Repeal Act (H.R. 3276) would repeal the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, H.R. 3277 would allow an above-the-line deduction for health insurance premiums, and H.R. 3278 would provide for cooperative governing of individual health insurance coverage. Press release: