Senate Expected to Vote on PPACA Repeal Legislation this Week

EDITOR’S NOTE: The Congressional Budget (CBO) on Monday scored the proposed Senate bill reporting 22 million more uninsured by 2026.

On June 22, U.S. Senate GOP leadership unveiled the Better Care Reconciliation Act of 2017 (BCRA) to repeal the Patient Protection and Affordable Care Act (PPACA), known colloquially as “Obamacare” – and despite fears to the contrary, the new legislation does not call for funding cuts to, or the elimination of, the Center for Medicare and Medicaid Innovation (CMMI).

The draft bill addresses Medicaid expansion, the employer and individual mandates, coverage subsidies, and a number of other policies established in the Patient Protection and Affordable Care Act. The new legislation was a byproduct of the 13-member working group comprised of committee leadership and members of various factions of the Republican party.

The Senate proposal would maintain the current enhanced federal match rate for expansion states through 2020. But in 2021, there would be a rollback spread over three years, decreasing to 85 percent in 2021, 80 percent in 2022, and 75 percent in 2023. By 2024, the federal match rate would be eliminated.

The draft Senate bill would maintain the advanced premium tax credits for individuals, but restructure them from what was established in the PPACA. Individuals between 0-350 percent of the federal poverty level would be eligible for a tax credit, which was set at 0-400 percent under the PPACA.

The draft bill repeals the Medicaid Disproportionate Share (DSH) hospital payment reductions starting in fiscal year 2018 for non-Medicaid expansion states. It also provides $2 billion in federal funding for states to respond to the national opioid abuse crisis in 2018.

Along with concerns for CMMI, other issues had arisen regarding implications for delivery system reform efforts and accountable care organizations (ACOs), but those have been tabled in both the House and Senate proposals.

Senate Majority Leader Mitch McConnell (R-Ky.) indicated his intention to have the bill considered by the Senate before the July 4 recess. The bill does not currently have a score from the Congressional Budget Office (CBO), but one is expected early this week.

The proposal is not expected to receive any support from Democrats, and several Republicans have expressed their concerns about the bill for a variety of reasons, so the future of the bill is uncertain. The House passed its version of a PPACA repeal, the American Health Care Act, on May 4.

The full text of the bill is available here, and a section-by-section summary of the draft legislation is available here.