Republican senators will continue discussions this week on revisions to legislation narrowly approved by the House -– the American Health Care Act – to repeal and replace much of the Affordable Care Act (ACA). Passing a bill out of the Senate may be an even tougher fight for Republicans, who can’t afford more than two defections.
The talks are driven in part by concerns of moderate GOP senators about the House bill’s creation of a waiver system that could substantially raise premiums for certain individuals. The waivers would let states opt out of ACA insurance standards for age rating and “essential health benefits” (EHBs) and, in certain cases, community rating protections related to pre-existing conditions. A number of centrist senators also want to make the bill’s refundable tax credits more generous -- particularly for the elderly -- and delay its phase-out of the ACA’s Medicaid expansion.
While much of the discussion aimed at bridging the conservative-centrist divide is being led by an official working group of 13 lawmakers appointed by Senate Republican leadership, members of the group say they are soliciting the views of all GOP members. Senate Republican leaders say there is no set timeline for legislation but face immense pressure to produce a proposal in short order so they can move to tax reform and other parts of their legislative agenda.
The debate will likely intensify next week, when the Congressional Budget Office is expected to release its analysis of the House-passed bill. The forthcoming score will reflect the language creating the state waiver system added to the bill just before House approval. To avoid a Democratic filibuster, Senate “reconciliation” rules will force the GOP to remove provisions that do not affect the budget.
If a bill passes the Senate, House Republicans could finish the process by passing the Senate’s bill without amending it. Alternatively, Republicans could iron out differences in a “conference committee” comprised of members from both chambers. Hard-line conservatives in the House may object to the Senate’s changes, which are likely to water down some of the American Health Care Act’s major provisions. The two chambers must agree on a uniform bill, however, before it can be sent to the president.