Senate Majority Leader Mitch McConnell announced Tuesday that he will delay the start of the Senate's August recess by two weeks in order to give the chamber more time to work on its repeal-and-replace bill for the Affordable Care Act, as well as a number of other legislative priorities. In recent weeks, several Republican senators have urged McConnell (R-Kentucky) to either delay or cancel the recess, arguing that the party needed more working days to deal with its very full legislative plate.
The announcement also comes as the GOP continues to search for the 50 votes it needs to pass an Obamacare repeal-and-replace bill. Ten Republican senators have now come out publicly against the version of the Better Care Reconciliation Act that was unveiled before the July 4th recess, and others in the party have expressed pessimism that they'll be able to pass a bill. The GOP has been revising the BCRA in the hopes of gaining more votes. Leadership says they plan to release the revised legislation on Thursday, hope to have a Congressional Budget Office score by early next week, and to vote at the end of next week.
At present, Republicans are still divided over big issues like how to handle the Medicaid expansion population, overall future Medicaid spending caps, and how much of the ACA's regulatory rules should be rolled back. A new amendment, the Consumer Freedom Amendment, proposed by Senators Ted Cruz (R-Texas) and Mike Lee (R-Utah), would allow insurers to sell plans that don't meet the ACA's rules (as long as they also offered ACA-compliant plans). But that too has also caused divisions within the party.
"The average low-income family would be significantly worse off."
Moderates worry the amendment would effectively destroy many of the ACA's most popular rules since it would likely result in young, healthy consumers (who don't see a need for robust coverage) flocking to non-compliant plans, leaving only older, sicker people in the ACA-compliant plans—a state of affairs that would dramatically increase premiums for those plans. People with pre-existing conditions, in other words, would technically be able to purchase ACA-compliant plans, but only at a very high cost.
Health-care policy experts, even conservative ones, are similarly concerned. "There's a virtue to flexibility in insurance design, but there's no virtue to splitting risk pool," Douglas Holtz-Eakin, the president of the conservative American Action Forum who served as the director of the CBO under President George W. Bush, told Politico last week. "It just doesn't sound like it would work out very well."
Cruz has argued that the BCRA contains enough money to stabilize the ACA-compliant risk pool, and moderates are reportedly attempting to tweak the amendment to win more support. Still, health-care policy experts remain skeptical. Further complicating the GOP's ACA repeal-and-replace circus is Senator Lindsey Graham (R-South Carolina), who announced this morning that he and other senators are working on a "fundamentally different" alternative health-care plan that he expects will attract some Democratic support.
Meanwhile, a new report out this morning from Linda Blumberg (whose research we've covered before), Matthew Buettgens, and John Holahan of the Urban Institute's Health Policy Center offers a timely look at who stands to gain and who stands to lose under the BCRA. The researchers analyzed the net financial effects for households across the income distribution. The chart below, from the report, illustrates what they found:
"[T]aking both tax reductions and benefit reductions into account, the average high-income family would be significantly better off, and the average low-income family would be significantly worse off," Blumberg and her colleagues conclude. "The average family with less than $10,000 of income in 2026 would be $2,550 worse off, a net reduction of more than 60 percent of the family's income.... Most of the gain for high-income families would be concentrated among families with incomes above $1,000,000. The average gain for this group would be $49,000, a net increase of 1.5 percent of income."
Perhaps that's why the bill is so unpopular—recent polling finds that only 17 percent of Americans approve of the BCRA.