Will McCon­nell suc­ceed in pass­ing ACA re­peal bill?

Modern Healthcare - - THE WEEK AHEAD - —Har­ris Meyer

This prom­ises to be one of the most tur­bu­lent, con­se­quen­tial weeks in U.S. health­care his­tory, as Se­nate Ma­jor­ity Leader Mitch McCon­nell tries to quickly pass a far-reach­ing bill, un­veiled only last Thurs­day, to re­struc­ture and cut Med­i­caid and re­shape the in­di­vid­ual health in­sur­ance mar­ket.

The Bet­ter Care Rec­on­cil­i­a­tion Act of 2017, along with its House-passed cousin, the Amer­i­can Health Care Act, faces in­tense op­po­si­tion from Democrats; provider, pub­lic health and con­sumer ad­vo­cacy groups; and safety-net health plans. It also has elicited skep­ti­cism from both con­ser­va­tive and mod­er­ate Se­nate Repub­li­cans, whose votes McCon­nell needs to pass the bill with a bare ma­jor­ity un­der bud­get rec­on­cil­i­a­tion rules.

Early this week, the Con­gres­sional Bud­get Of­fice will of­fer its as­sess­ment of the bill’s cov­er­age and cost im­pact. That will weigh heav­ily on whether and how McCon­nell has to re­vise his mea­sure to re­peal and re­place the Af­ford­able Care Act. If it doesn’t match the 10-year deficit re­duc­tion in the House bill, he may have to dial back its cov­er­age pro­vi­sions or re­store some ACA taxes slated for rapid obliv­ion.

If the CBO projects cov­er­age losses any­where close to the 23 mil­lion fig­ure it es­ti­mated for the House bill, GOP mod­er­ates such as Susan Collins of Maine, Jeff Flake of Ari­zona, Dean Heller of Ne­vada, and Rob Port­man of Ohio may run for cover. And if the bud­get um­pire says it would drive up pre­mi­ums and out-of-pocket costs, it could spook con­ser­va­tives such as Mike Lee of Utah and Rand Paul of Ken­tucky.

Be­fore the vote takes place later this week, Se­nate par­lia­men­tar­ian El­iz­a­beth MacDonough could rule that pro­vi­sions im­por­tant to con­ser­va­tives, such as de­fund­ing Planned Par­ent­hood and bar­ring use of pre­mium tax cred­its to buy plans cov­er­ing abor­tion, aren’t al­lowed un­der bud­get rec­on­cil­i­a­tion rules. That could blow up McCon­nell’s frag­ile coali­tion.

“This is go­ing to be one of the tough­est strong-arm votes we’ve seen in Wash­ing­ton in a long time,” said Lawrence Ja­cobs, a vet­eran health pol­icy ob­server at the Univer­sity of Min­nesota. “It’s not high prin­ci­ple. It’s raw power.”


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