QUESTIONS LINGER ON HEALTH CARE VOTE
Senate’s version could look quite different from House measure that narrowly passed
The House has passed its version of an Obamacare repeal bill, and the Senate now gets to work. But as legislative gears continue to grind, there are still key developments to watch for that could have a dramatic effect on the debate over repealing and replacing the Affordable Care Act.
1 DOES CBO ISSUE A TERRIBLE SCORE OF THE HOUSE BILL?
The Congressional Budget Office’s March review of the first version of the House bill was a death blow. It concluded the bill would lead to 24 million fewer people having health insurance by 2026, and even though Republicans pointed out many would be people choosing not to be insured, the damage was done. House leaders raced the new version of the bill to a floor vote before the CBO could issue a revised score.
If CBO still comes out with an analysis predicting a dramatic drop in the number of people insured or a dramatic increase in premiums, it will give the Senate more leverage to write a more moderate version of the bill.
2 DOES THE ADMINISTRATION WITHHOLD COST- SHARING SUBSIDIES?
Under the ACA, the federal government is paying insurers about $ 7 billion a year to reduce out- of- pocket insurance costs
for people who earn less than 250% of the federal poverty limit. House Republicans had sued the Obama administration to stop those payments; the Trump administration has been temporarily funding the subsidies while the lawsuit is pending but has not said how long it will continue to do so.
Stopping those payments could prompt the explosion of the individual market Republicans have predicted — and it could create enough of a crisis to prompt the Senate to support the House bill.
3 DOES THE SENATE START OVER?
Within minutes of House passage of the bill, moderate Senate Republicans were announcing they would not be able to support it. Sen. Lamar Alexander, R Tenn., who chairs the Senate Health, Education, Labor and Pensions Committee, said, “We’ll use it as a resource, but we’ll be writing our own bill.”
Writing a new bill could take months and would leave House leaders this summer with the same problem they faced this spring: convincing their most conservative wing to sign on to a bill that is not as dramatic a repeal as they want.
4 DO MORE INSURERS DROP OUT?
President Trump has said the Affordable Care Act will collapse on its own because insurers will continue to walk away from the Obamacare exchanges, leaving no options for consumers to get coverage. If that happens quickly enough, it could increase pressure on senators to move more quickly on a repeal plan so their constituents can find coverage options.
Trump cited Aetna’s announcement Wednesday that it would no longer offer individual insurance plans in Virginia as evidence of an Obamacare death spiral. The departure leaves 27 counties in the state with one insurer, though that’s better than Iowa, which is expected to lose the only insurer left selling individual plans in most of the state.
5 WILL THERE BE MORE ANGRY TOWN HALLS?
House members head home for a one- week recess, and it is worth watching how their constituents react to the bill they just passed. Town hall events have been raucous this year, with protesters attacking Republicans for trying to gut Obamacare.
Now that they have actually passed a bill, will grateful Republicans come out to thank them, or will it just be more outrage?