A group of Senate Republicans continue working on their version of a bill to repeal and replace the Affordable Care Act. Reports are that they may try to bring their legislation to the Senate floor for a vote the week of June 26 in the hopes of passing it before the week-long July 4 recess. The Senate GOP bill is expected to be very similar to the House-passed repeal bill; Sen. John Cornyn (R-TX) told reporters that “80 percent of what the House did we’re likely to do.”

One difference in the Senate bill might be a “phase out” period for ending the Medicaid expansion allowed under the Affordable Care Act. Several GOP senators are supporting a plan to gradually phase down the federal funding for Medicaid expansion over a seven-year period from 2020 to 2027. The willingness of senators including Portman (R-OH) and Heller (R-NV) to support a bill with a seven-year phase-out of the Medicaid expansion is a new development that increases the chance of finding a majority, unless this change drives away the most right-wing senators. However, as the Center on Budget and Policy Priorities points out, a gradual phase-out would not preserve coverage for the millions expected to lose it once the Medicaid expansion finally ended, and millions would still lose coverage even in the short term. As CBPP explains, at least eight Medicaid expansion states have “trigger laws” under which their Medicaid expansions automatically end if the federal matching rate for expansion enrollees falls at all, which it would in 2020. People who now have coverage under the expansion in these states would suffer the same fate – loss of insurance – as they would under the House bill. Other expansion states may likely freeze enrollment for folks in the expansion beginning in 2020 due to rising costs; CBPP therefore estimates that expansions would be more than two-thirds gone by the end of 2021 and virtually eliminated by the end of 2024, even with a seven-year phase-out. A cost estimate of the Senate bill from the Congressional Budget Office, Congress’s nonpartisan scorekeeper, is not expected until shortly before the Senate vote.

Reports from CQ out on June 9 stated that the Senate bill may contain money to help stabilize the individual insurance exchanges. The Trump Administration has refused to say whether it will continue to fund the ACA’s cost-sharing subsidies provided to health insurance companies that help reduce out-of-pocket health care costs like deductibles for lower-income people. Insurers have said those subsidies are necessary for the stability of the individual market. Some insurers have also pointed to the uncertainty around the continued payments of the subsidies as the cause for either pulling out of the exchanges or increasing premiums.

Advocates were quick to denounce the May 4 move by the House of Representatives to pass (217-213) the American Health Care Act, which repeals the Affordable Care Act enacted under President Obama. According to the Congressional Budget Office, Families USA and others, the bill will strip coverage from 23 million Americans; require millions more people to pay thousands of dollars more each year for coverage and care; slash $834 billion out of Medicaid over the next decade by ending the ACA’s Medicaid expansion and by cutting federal support for state Medicaid programs, forever ending the program in its current form; gut protections for people with pre-existing conditions; eliminate the national requirement that health plans cover basic benefits; and let employers and insurers impose lifetime and annual limits on coverage. It would also give hundreds of billions of dollars in tax cuts to millionaires, with the wealthiest 400 Americans getting an average tax cut of $7 million a year each. Even Senate Republicans acknowledged that the House bill as it stands could not does not have the support to pass the Senate, even though Senate leaders plan to use a special process known as reconciliation where only 51 votes are needed.

Advocacy organizations have been busy encouraging advocates to contact their Senators to urge them to keep the Affordable Care Act, protect Medicaid and the subsidies in the ACA, and ensure coverage for individuals with pre-existing conditions.

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