It Ain’t Over. And the Solution Might…Just Might!...Be Bipartisan

The release of the Senate health bill last week – Better Care Reconciliation Act (BCRA) – and the CBO score this week sent Senate Republicans into high gear to round up the required 50 votes needed to pass the bill (with VP Pence to break the tie).

The CBO projected that 22 million fewer people would be insured under BCRA than under current law, and three Senators immediately voiced their lack of support for the bill; several more followed. At the Republican caucus on Tuesday, Senate majority leader Mitch McConnell called off the vote to allow time to consider changes required to garner the necessary votes. If you are among those who think the Senate bill is DOA, you might want to give it a little more time. To refresh our memories, Vox ran an article that chronicled the journey of the House health reform bill, which was also pulled when votes were lacking only to be passed two months later.

The current plan for the Senate is to have an updated draft of the bill by Friday so the CBO can re-score it next week, with a vote mid-July. There were a couple of compelling takeaways from the article. First, it is really hard to get members to support a bill of this magnitude within a week of introduction. The legislative process allows for hearings, amendments, testing with constituents, and working the spin to sell it back home. Many senators have been unsettled by fast-track timing, but that’s not the same as objecting to the content of the bill. Second, don’t underestimate the power of the Republican motivation to get this done, even if it doesn’t exactly address all the issues they have with the current law. In fact, a New York Times article raised the possibility that, in order to get healthcare reform out of the way so Congress can deal with other issues the Republicans might even consider – wait for it – working with Democrats on a smaller bill to shore up the individual market and make some fixes to unpopular ACA provisions.

Bipartisan legislation? Sounds crazy we know, but there has been talk. According to the Times article, GOP Senator Lamar Alexander of Tennessee, chairman of the Senate health committee, has said he would like to draft legislation to stabilize the marketplaces and provide a temporary continuation of subsidies to insurance companies to offset out-of-pocket costs. That’s a bill Democrats could conceivably support. Republican Senator Susan Collins of Maine, an opponent of the BCRA in its current form, said she wanted to work with members of both parties to ''fix the flaws'' in the ACA. And Senator Shelly Moore Capito, another BCRA opponent, said on CNN on Wednesday that if a Republican bill fails, ''the floodgates would probably open to reach a bipartisan compromise.''

Of course, Senate Majority Leader Mitch McConnell would need to get on board, and any such compromise bill would probably be considered a last resort.  But it’s a tantalizing thought. What if Democrats and Republicans worked together to repair the ACA and then went on to rein in drug prices, or help small businesses with employee health costs? What if, as Senator John McCain said when asked about the chances of a bill passing this week, pigs could fly?

Tracy Watts
by Tracy Watts

Senior Partner, National Leader for U.S. Health Policy

Beth Umland
by Beth Umland

Director of Research, Health, Mercer

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