Employee Benefits Compliance

Senate Votes to Open Debate on HCR Bill

US Capitol Building

The Senate just voted 51-50 to open debate on the Senate bill to repeal-and-replace the Affordable Care Act (ACA). Note that this is NOT a vote on the Senate bill itself, which is called the Better Care Reconciliation Act (BCRA).  Today’s vote (July 25, 2017) was 50-50, and Vice President Pence cast the tie-breaking vote.  The two republican Senators who voted against the measure were Susan Collins (R-ME) and Lisa Murkowski (R-AK).  Additionally, all the Democrats voted against it.

Again, this is NOT a vote on the Senate bill itself. Rather, it is a procedural vote that permits the Senate to now determine what will be in the final Senate bill. The Senate will soon move forward with a “vote-a-rama” – where it will vote on all amendments offered by all Senators.  This could take a while.  The Republicans will likely vote against all amendments offered by Democrats, and vice-versa. However, it is possible some moderates on either side will introduce some amendments intended to secure a vote or two from the other side.  Some amendments the Senate might vote on include:

  • Senator Rand Paul’s (R-KY) amendment to fully repeal the ACA
  • Senator Ted Cruz’s (R-TX) amendment to allow for “skinny” insurance plans that do not comply with all ACA requirements, as long as those carriers also offer plans that are ACA-compliant.
  • An amendment by Senators Dean Heller (R-NV) and Martin Heinrich (D-NM) to fully repeal the cadillac tax.
  • Various amendments by Democrats (yet to be proposed) to preserve ACA’s prohibitions on pre-existing conditions and life-time limits, as well as ACA’s mandated coverage requirements for maternity care, 100%-paid preventive benefits, and other “essential health benefits” (EHBs).
  • Amendments regarding the ACA’s Medicaid expansion provisions: Republicans may propose amendments to repeal or limit Medicaid expansion, and Democrats may offer amendments to keep it or to limit proposed reductions by Republicans.
  • Senator Lindsey Graham’s (R-SC) amendment to retain many of the ACA protections but NOT the individual and employer mandates, not repeal the ACA taxes, and turn over the ACA funds to the states through a block grant, so each state could decide how to provide health care to its residents.

It’s anyone’s guess what the final bill will look like, or if there will even be a bill that garners 51 votes. According to the Council on Insurance Agents and Brokers (CIAB), “the final legislation could simply be a clean repeal of the individual and employer mandates, and a repeal of most of the ACA taxes. But anything can happen at this point.”