What is happening with Obamacare now?
The Senate is currently debating on repealing the Affordable Care Act (ACA). After ailing Republican health bills, Senate leadership got enough support to at least start debate on Tuesday.
No one knows how this week will end, including those running repeal efforts. The only guarantee is that there will be stumbles. The Senate is looking to pass a health bill, allegedly by Friday, using reconciliation. This means the final bill needs to adhere to budget rules to pass with a simple majority. The Senate also needs to adhere to a strict schedule.
Here are the next steps:
Wednesday, July 26: One ACA repeal-only bill fails.
The Senate voted first on the Obamacare Repeal Reconciliation Act (ORRA), with a Rand Paul amendment. The Paul amendment would ban federal funding of abortion. This failed. There is also no public version of this revised bill. This is a proxy vote on repealing the Affordable Care Act and defunding Planned Parenthood. Both live to see another day.
4:11 pm tally: 45 to 55, with seven Republicans and all of the Democrats opposing.
Next, the Senate will vote on a second ORRA bill, without abortion language.
The tally: Coming soon
The Senate voted on a third provision, proposed by Sen. Joe Donnelly (D-IN). The Donnelly motion looked to send the House-passed bill back to committee and report back without the Medicaid coverage provisions. This failed.
4:30 pm tally: 48 to 52
Tuesday, July 25 at 9:22 pm: The ACA repeal and replace bill fails.
The Senate voted against a version of the Better Care Reconciliation Bill (BCRA), which included a revised amendment by Senator Ted Cruz (R-TX). The procedural vote was technically on whether the amendment complies with the budget act. The failed vote means that the Senate cannot pass BCRA as is, with a simple majority. Repeal and replace is not dead, but it’s definitely on life support.
The tally: 43 to 57, with nine Republicans and all of the Democrats opposing
Bills, Bills, Bills
The Senate will be voting on a ton of bills that will amend the House health care bill this week. It’s important to keep in mind that if something passes on Friday, it will likely be one of three proposals:
1. ACA Repeal and Replace
There have been several iterations of the BCRA. All BCRA versions drastically change the ACA marketplace and Medicaid program. All versions also change benchmark plans offered, so that insurance companies pay less out-of-pocket costs. This means costlier copays and deductibles for the average American than under current law. States have the option to waive market regulations, which means people who buy insurance will buy plans that cover the bare minimum. Lastly, all versions cut Medicaid expansion and gut federal spending to the program overall.
The Congressional Budget Office (CBO) has not scored every version of BCRA. It is working to score the version of BCRA that includes the Cruz amendment. Under two versions the CBO has scored, 49 million would be uninsured in 2026, 22 million more than under current law. People on Medicaid insurance will be the largest group affected.
This bill also has many reconciliation problems. As of now, the revised bill cannot pass with simple majority because it breaks a lot of Byrd rules.
2. ACA Repeal-only
There is only one public version of the Obamacare Repeal and Reconciliation Act (ORRA). This bill partially repeals provisions of the ACA like the insurance mandate, Medicaid expansion, and ACA marketplace premium subsidies. It keeps marketplace patient protections.
The CBO estimated that 32 million people would lose insurance under ORRA, the most of any of the Republican proposals.
3. ACA “Skinny” Repeal
There is no language for this bill, yet. There are rumors circulating on Capitol Hill that this is the only bill that could pass Friday. It’s the only one that complies with budget rules, and the allegedly has enough support. The bill would eliminate the least popular provision of the ACA: the individual and employer mandate. The bill would purportedly rescind a tax on medial devices. Everything else in the ACA will remain untouched.
The CBO has not scored this bill, because there is no bill. Even so, some health experts say the ACA marketplace will take a hit under this bill. Insurance companies will likely raise premiums, up to 20 percent. Some people may drop coverage because they no longer are required to have insurance or because it’s too costly. With no mandate, insurance companies could pull out of the marketplace, leaving people with limited or no options.
This is a breaking news story and will be updated accordingly.
Obamacare Repeal Tracker: Partial repeal of the Affordable Care Act fails in the Senate was originally published in ThinkProgress on Medium, where people are continuing the conversation by highlighting and responding to this story.