Congress is in recess this week so there has been no official action on healthcare in the Senate. There is a draft bill written by the Senate leadership, but it failed to get enough support for even a motion to take up consideration of the bill, to begin debate and offer amendments, to pass. As with the original House bill, conservatives did not think the Senate bill went far enough in undoing the Affordable Care Act (Obamacare) and moderates thought it went too far in reducing spending on Medicaid, in potentially raising insurance costs for older, sicker Americans, and in failing to address the opioid epidemic. Democrats have unanimously withheld support for the majority’s approach to healthcare reform.
The Congressional Budget Office (CBO) projected that at the end of ten years, 23 million fewer people would have coverage than they would under current law. CBO also projected that a change in the inflation adjustment for Medicaid ten years from now would result in a 35 percent reduction in Medicaid spending by the end of the following decade. Changes in the structure of Medicaid would leave it up to the states whether to help make up the difference.
Senate leadership sent a revised bill draft to CBO for another cost/benefit analysis during the recess week. The challenge is to make the bill more conservative, possibly by making it easier for states to opt out of coverage requirements or consumer protections, while attracting moderates with more spending on their priorities. The majority must get 50 of its 52 members to support the legislation.
The CBO estimate is important not only for debating the merits of the healthcare legislation but also for the tax reform bill Congress wants to take up next The official savings on healthcare from reducing Medicaid spending can be used to pay for tax reductions in the tax bill. Some of the savings may instead be redirected back into spending on the healthcare bill but there is a tax-related disincentive to do so. Passing the bill with only majority party support is a delicate balancing act with numerous moving parts. The House majority failed to pass its bill on the first try, but eventually it did so. Whatever can pass the Senate must then go back and pass the House as well.
It does not appear that there will be a vote in the Senate next week (the week of the 9th) while the revised draft bill is discussed. You can call your Senators at 202-224-3121.