The Senate Majority Leader, Republican Sen. Mitch McConnell of Kentucky, has unveiled a revised version of the Better Care Reconciliation Act, the GOP proposal to repeal and replace the Obama administration's Affordable Care Act, commonly called "Obamacare."
McConnell originally planned to hold a vote on the BCRA before the chamber's July 4 recess. He delayed a vote to overhaul the legislation after it became clear that it did not have enough GOP support. The Congressional Budget Office estimated that the original BCRA would result in 22 million fewer Americans having health coverage by 2026 than if the ACA was kept in place, according to The New York Times.
McConnell revealed an updated version of the health care bill during a July 13 meeting with GOP lawmakers. The revised BCRA would still roll back Medicaid expansion and impose caps on how much federal funding states would receive for the program.
The bill has also implemented an amendment proposed by Republican Sen. Ted Cruz of Texas, which would allow insurance companies to offer low-cost plans that would provide minimal benefits. These plans would not meet the minimum standards for ACA benefits, but insurance companies would be able to offer them in states where they also offered plans that did meet the ACA criteria.
Critics of the Cruz amendment have argued that it would result in healthy Americans flocking towards the low-cost plans, resulting in premium increases for those with pre-existing conditions. While the original BCRA offered over $100 billion to help subsidize premiums and out-of-pocket costs, the revised version would add an additional $70 billion.
The updated bill would also allow Americans to use their tax credits to pay for catastrophic health plans, or coverage with low premium costs and high deductibles. It would also allow Americans to use money in their health savings accounts to pay for their premiums.
The new BCRA also dramatically increased federal funding to address the opioid crisis from the originally proposed $2 billion to $45 billion. Lastly, it would preserve several ACA taxes that the original GOP bill sought to remove. The updated legislation would keep the 3.8 percent investment income tax and and 0.9 payroll tax on individuals making over $200,000 and families making over $250,000 per year.
On July 17, the CBO is slated to release an estimate of how the updated BCRA would impact the insurance market. McConnell has aimed to begin debate on the bill that week, Politico reports.
The Senate Majority Leader can only afford to lose two Republicans if the bill is to pass. The GOP currently holds 52 seats in the Senate; in order to pass the BCRA through budget reconciliation and without Democratic input, McConnell would need to garner 50 Republican votes, with Vice President Mike Pence serving as a tiebreaker.
Health insurance experts remain critical of the updated BCRA, blasting its cuts to Medicaid.
"We're still likely to see many millions of people losing or going without coverage as a result of this bill. Although some of the taxes on wealthy people are retained, the bill doesn't appear to use much of that to cover low-income people," associate director Cynthia Cox of the Kaiser Family Foundation told Business Insider.
Republican Sens. Susan Collins of Maine and Rand Paul of Kentucky have already signaled that they will not vote for the updated BCRA, meaning that the legislation could fail to pass if another Republican comes out against it.
"At this point, I cannot support the bill," Paul said after the updated BCRA was released, according to Fox News. "The new bill is actually less of a repeal than the old bill... they’ve taken the bill and made it worse."
On July 12, President Donald Trump warned that he would be displeased with McConnell if the BCRA did not pass in the Senate.
"I will be very angry about it and a lot of people will be very upset," Trump told CBN News. "But I'm still waiting for that bill to come to my desk... Mitch has to pull it off."