July 18, 2017 — Last-minute defections from two Republican senators early Tuesday ensured the chamber’s version of the Better Care Reconciliation Act (BCRA) would not have enough votes to secure passage. President Trump and GOP leadership indicated that despite this latest defeat, they would continue to work on legislation to repeal and replace the Affordable Care Act (ACA), popularly known as ObamaCare.
According to the Washington Post, Sens. Mike Lee (Utah) and Jerry Moran (Kan.) issued statements prior to Tuesday’s planned vote that they would not support the revised measure. Sens. Rand Paul (Ky.) and Susan Collins (Maine) had already voiced their opposition to both versions of the Senate bill, and Senate Majority Leader Mitch McConnell (Ky.) could only afford to lose two votes and still secure passage.
The second version of the BCRA, authored by McConnell and GOP leadership, aimed at appeasing more moderate Republicans and expanding aid for lower-income people. The revised bill added back several taxes imposed by the ACA, including the net investment income tax, the additional Medicare Health Insurance Tax and a tax on high-earning health insurance executives. From a coverage perspective, Republicans’ new version of the bill would have allow insurers to sell stripped-down plans without many of the Obamacare requirements as long as they offered at least one policy that did.
Much of the backlash over the bill has stemmed from its slow reduction of the ACA’s Medicaid expansion. These provisions were largely unchanged in the revised version: The Medicaid program would be changed from an open-ended entitlement to a fixed amount of money granted to states based on enrollment or as a block grant, and the annual growth rate of those funds would be reduced beginning in 2020.
In the interest of expanding care, the bill set aside $70 billion for states to help consumers with paying out-of-pocket costs in the form of cost-sharing or health savings accounts. The $70 billion was in addition to the $112 billion earmarked for the same purpose in the original bill.