Last Thursday, Senate leadership released their long-awaited version of the House-passed healthcare bill, the Better Care Reconciliation Act (BCRA). In large part, the bill is similar to the House version, the American Healthcare Act (AHCA), with some key changes. The Medicaid rollback happens later but is more substantial than in the House version, and the structure of premium tax credits looks more similar to Obamacare than in the House version.
Importantly, the Senate version also does not include the controversial “continuous coverage” provisions the House had used as a replacement for the individual mandate. And the Senate version will cut the deficit more than the House version would have.
The so-called MacArthur amendment set up a new structure for states to opt out of certain Obamacare regulations and helped the AHCA pass the House. In the Senate version, this framework is not included; instead, the Senate would change the structure of existing state opt-outs (known as “1332 waivers”) that were in Obamacare to begin with but rarely used, by switching the burden of proof and seeking to ease the financial burdens of states applying for them.
As expected, the Congressional Budget Office has also projected that millions of people will no longer hold insurance — although it’s important to note both that a large amount of expected changes are due to ending the individual mandate and that these projections can be fairly criticized.
Many of the concerns that fiscal conservatives had with the AHCA remain in this new version and are likely to remain with whatever compromise version eventually passes — assuming the Senate can pass its own version after the July 4th recess. With several Senators already announcing their opposition and the President himself suggesting a different plan Friday morning, there is a rough road ahead.
It’s difficult to say what happens next. And frankly, for fiscal conservatives, it’s deeply disappointing that there is apparently not political will among Republicans to do the thing they have spent the last seven years promising to do.
Major deficit reduction in a time when any cuts are few and far between is worth applauding, but whether one believes this framework is a step toward long-term cost reductions and free-market policy largely depends on one’s perspective and tendency to trust Republican leadership.
If this is, indeed as we have been been assured, both the only framework that can gain a majority and be passed under reconciliation and the first step of many toward free-market, fiscally conservative solutions, then there is room for optimism.
If this framework is the best and last Congress manages to do after promising for nearly a decade to repeal Obamacare root and branch, then we should be very disappointed indeed.
Fiscal conservatives should keep a very close eye as negotiations continue– and push to make the current framework better while making sure no one in Congress is content to stop there.