Senate Releases Plan for Repealing Affordable Care Act, as Cancer Advocates Weigh In

This morning, Senate Republican leaders released the draft of a bill to repeal and replace the Affordable Care Act (Obamacare).

On the Senate floor today, Senate Majority Leader Mitch McConnell (R-Kentucky) said, “Republicans believe we have a responsibility to act and we are. For our constituents, for our states, and for our country.”

The Senate plan in many aspects is like the “American Health Care Act” passed by the US House of Representatives May 4 in a 217-213 vote. However, the Senate bill, called the Better Care Reconciliation Act of 2017 (BCRA), would factor in age, income and geography when determining financial assistance to help individuals pay their premiums, whereas the House version did not include income in this calculation.

Both the House and Senate versions propose large cuts to Medicaid and would phase out Obamacare’s expansion of the program, although the Senate version would phase the Medicaid expansion out more slowly; both bills would also convert Medicaid to a block grant program.

Other ways the Senate bill differs from Obamacare include repeal of the mandates that individuals carry health insurance and that employers with 50 or more employees provide it. Additionally, where the ACA allowed insurers to charge a maximum of three times their lowest rate to older consumers, this bill changes that age rating to 5-1 — meaning insurers would be able to charge older adults up to five times what they are charging younger adults.

Holdover protections the Senate retained from Obamacare are the provisions allowing individuals to remain on their parents’ health insurance through age 26 and preventing exclusion based on preexisting conditions. The Senate bill does not include stipulations which allow states to charge individuals more based on preexisting conditions, which the House bill included. However, it does grant states more flexibility in deciding the rules of insurance in their state.

Also, funding for cost-sharing reduction payments, which decrease the out-of-pocket costs for some low-income individuals, will continue through 2019.

In a statement on June 20, McConnell stated that Obamacare trends are unsustainable and this legislation to repeal and replace the law is necessary due to the instability of the insurance market and insurers dropping out of exchanges, leading to higher costs and less choices for many consumers.

Senate Minority Leader Charles E. Schumer (D-New York), however, countered that these proposed changes, “will result in higher costs, less care, and millions of Americans will lose their health insurance, particularly through Medicaid.”

The Cancer Action Network of the American Cancer Society joined other advocates in a #KeepUsCovered campaign while waiting for the senators to release their draft health care reform bill, following several days of private deliberations. The advocacy group’s efforts include spearheading a Senate letter-writing campaign urging senators, “to make sure that patients with cancer have access to quality, affordable coverage that maintains protections from pre-existing conditions discrimination,” and participating in an event on Capitol Hill yesterday in behalf of patients with cancer and survivors.

Following release of the Senate draft legislation, the National Coalition of Cancer Survivorship posted on twitter, “Health care legislation should improve our health care system, increasing access and affordability to quality health care for the American people, and should be negotiated (as all bills should) in an open and democratic process”; in an email alert today the NCCS urged survivors to contact their senators with concerns about the just-released bill.

The Senate is expected to vote on its version next week before the July 4th recess. While no Republican senators have yet signaled how they will vote, there is only room for 2 Republicans to vote no; any more, and the bill would not have the numbers to pass without any Democratic support.

The Congressional Budget Office (CBO) is also expected to “score” the Senate bill sometime next week to provide an assessment of its cost and overall impact on coverage. CBO’s projection of the number of uninsured under the House version of the repeal and replace bill was that 23 million more Americans would be uninsured by 2026 compared with current law.