Top takeaways from the week: 1) Today, Senate Republicans released a discussion draft of their repeal and replacement legislation, which is expected to move to the Senate floor for a vote early next week, 2) Congressional Budget Office is expected to release a score of the legislation on Monday, and 3) Wednesday was the deadline for issuers to file rates for participation in the plan year 2018 federally-facilitated Marketplace.

Senate Action –

Today, Senate leadership publicly released a discussion draft of their version to repeal the ACA, called the Better Care Reconciliation Act (BCRA) of 2017.

While the Senate version is more moderate than the House-passed bill, both are similar in their structure:

  • Medicaid Expansion – Medicaid expansion is repealed, although the Senate bill delays the full impact until 2024.
  • Medicaid Financing – The bill would impose per-capita caps and allow states to implement block grants, dubbed the Medicaid Flexibility Program. The bill would also allow states to impose work requirements for nondisabled, non-pregnant adults.
  • Tax Credits – The health insurance tax credits are similar to those in the ACA – credits are tied to income, a benchmark plan, as well as age, and must be used with a qualified health plan. Notably, the Senate bill changes the income eligibility for tax credits to 0-350% of the federal poverty level.
  • CostSharing Reductions – The bill would repeal CSRs beginning in 2020, but authorizes payment to issuers for obligations in FY18 and FY19.
  • Individual Mandate – Although the individual mandate is repealed, unlike the House version, there is no continuous coverage penalty, which is likely to stymy enrollment efforts. Senate leaders are reportedly working with the Senate Parliamentarian on an amendment that would replace the continuous coverage penalty.
  • Stabilization Funds – Authorizes funding to states to establish short-term and long-term market stabilization programs, including reinsurance, high-risk pools, and reducing out-of-pocket costs. In the short-term, the bill provides $15B in CY18 and CY19, and $10B each in CY20 and CY21. For the long-term program the bill provides $62B over 8 years from CY19 through CY2026.
  • 1332 Waivers – Promotes the use of 1332 waivers to increase access to coverage and reduce premiums. States can use premiums to waive ACA requirements for an exchange, definition of a qualified health plan, essential health benefits, and the use of tax credits, among others.
  • ACA Taxes – Repeals or delays all of the ACA taxes. The Cadillac tax is delayed until 2026 and the Medicare tax is delayed until 2023.

Press releases – Senate Budget Committee Chair Enzi (R-WY):  Senate Finance Chair Hatch (R-UT):  Senate HELP Committee Chair Alexander: HHS Secretary Price: CMS Administrator Verma: Senate Budget Committee Overview: Overview: Section-by-section: Discussion draft text:

Minority Leader Schumer (D-NY) and 30 Democratic Senators took to the floor shortly after the bill’s release, reiterating their objections to its deep cuts to Medicaid and tax breaks for the wealthy, and calling the bill “meaner” than the House bill.

Although Democrats have remained unified in their opposition, Republicans were less united in support for the bill as released, which needs 51 votes to pass.

Conservative Sens. Cruz (R-TX), Paul (R-KY), Lee (R-UT), and Johnson (R-WI) released a joint statement stating that they are not ready to vote for the bill in its current form but are open to negotiation and that “it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs.” Press release:

Moderate Sens. Heller (R-NV), Collins (R-ME) and Portman (R-OH) expressed concern with the bill’s impact on Medicaid. Sen. Heller noted his “serious concerns” about Medicaid while Sen. Portman noted he has “real concerns about the Medicaid policies in this bill.” Sen. Collins has also expressed concern, along with Sen. Murkowski (R-ME) over language that would defund Planned Parenthood.

Additionally, while the House-passed bill included $15 billion in funding over 10 years for substance abuse, mental health and maternity care, the Senate’s version only includes $2 billion in fiscal year 2018. Sens. Capito (R-WV) and Portman (R-OH) had strongly advocated for $45 billion in funding to states to help deal with the opioid crisis.

The Congressional Budget Office (CBO) released a statement announcing their intention to release its score for the Senate’s healthcare bill “early next week.” The Senate cannot vote on the bill until it has received the CBO’s score. Announcement:

Meanwhile, on Wednesday, Sen. Paul (R-KY) introduced a resolution (S. Res. 197) which would restrict the Senate from considering any bill or other matter until one session day has passed since introduction for every 20 pages included, and would allow any Senator to raise a point of order. Press release: Resolution:

House Action –

On Wednesday, Rep. Maloney (D-NY) introduced three bills that would require members of Congress from states that apply for various waivers from the ACA’s requirements to purchase coverage in line with those waivers. The No Carve Out for Congress Act (H.R. 2985) would restrict members of Congress who represent a state with an essential health benefits (EHB) waiver to the lowest actuarial value health insurance coverage that is available under that waiver. The Good for the Gander Act (H.R. 2986), would restrict members of Congress who represent a state with an age band waivers to the highest age band premium for coverage available under the waiver. The High Risk Pool, No Reward Act (H.R. 2984) would restrict members of Congress who represent a state with a waiver to the same coverage available under such waiver. Press release:

Administrative Action –

Although President Trump has not committed to supporting the current draft of the Senate bill, he commented today that the bill is “going to be very good” and that “Obamacare is dead and we’re putting a plan out today that is going to be negotiated.” He also noted that “We’d love to have some Democrats’ support but they’re obstructionists.”

On Wednesday, the White House unveiled a new webpage arguing for a repeal of the ACA, describing how the ACA has resulted in higher premiums, more costly deductibles, and fewer insurance options for Americans. Website:

Also on Wednesday, insurers submitted preliminary rate filings for the 2018. As these were preliminary filings, insurers have until August 16 to make any changes to their ACA plans and until September 27 to give notice of final participation.