Senate leaders say they are more optimistic this week about passing an Affordable Care Act replacement bill by the end of June, although deep divisions remain on a number of key issues, such as the fate of Medicaid.
After watching the House pass an ACA repeal bill that stood little chance in the Senate, Senate Republicans have spent the past month deliberating over how to proceed on health care and get it off their agenda before the Fourth of July recess so they can move on to other pressing issues like tax reform and infrastructure. To vote on a bill by the end of the month, Republicans would have to have their bill to the Congressional Budget Office about two weeks prior. Unlike the House, which did not wait for a CBO score before passing its bill, the Senate is required to come up with at least $133 billion in savings before its members vote on a bill due to complex budget rules known as reconciliation.
The Senate bill continues to be drafted behind closed doors by Senate Republicans, and Senate Majority Leader Mitch McConnell (R-KY) is pushing hard for his members to get behind ACA repeal or risk inaction on a priority issue that Republicans have campaigned on for seven years.
One of the most difficult decisions remaining is when to roll back the ACA’s Medicaid expansion and how much to cut Medicaid overall. The House bill passed last month would continue the ACA’s expanded federal funding levels for Medicaid until 2020 and then gradually phase them out. The House bill would also cut Medicaid funding by $834 billion over the next 10 years, according to the CBO.
Republican senators from states that expanded Medicaid under the ACA are anxious not to see people in their states lose coverage. Sen. Rob Portman (R-OH) said he will not support the House bill for this reason. Portman and Sen. Shelley Moore Capito (R-WV) have proposed a longer phase-out of federal funding for Medicaid expansion, beginning in 2020 and ending in 2027. Portman said states dependent on Medicaid funding need a “significant glidepath” to ensure people who currently have coverage under the program aren’t left without options.