US Senate Set to Try Again on Health Care Reform

U.S. Senate Republicans on Thursday (July 13) released a revised version of their bill to repeal and replace the Affordable Care Act, otherwise known as Obamacare. The changes in the revised version are aimed at securing the votes of reluctant GOP senators in order to win the bill’s passage.

The new Senate bill, like earlier versions, would convert Medicaid from an open-ended entitlement to a system of fixed (capped) payments to states. The new bill makes no change to the indexing that would be used to adjust future federal Medicaid outlays, which under the Senate version would be pegged to the consumer price index (CPI-U) rather than measures tied to medical care costs, which historically  have risen faster than the CPI.

The Congressional Budget Office (CBO) has projected federal outlays for Medicaid under the Senate bill would decline by 26 percent by 2026 in comparison with projections under current law. (See previous post.)

The size of this reduction has alarmed groups that advocate for persons with disabilities. Many school leaders are concerned about the potential impact of the reduction on schools mandated to provide special education services  under the federal Individuals with Disabilities Education Act (IDEA) (see previous post) and on the vision, hearing and other health screenings currently performed in schools.

Among other changes, the revised bill includes $45 billion in funding to address opioid addiction, adds $70 billion in additional funding (above the $100 billion already in earlier versions) for states trying to stabilize premiums and out-of-pocket costs, and would maintain certain taxes on wealthy individuals. Other changes in the new bill would allow individuals to purchase cheaper insurance plans that cover less than the range of medical services Obamacare requires and would allow the use of Health Savings Accounts to pay for premiums.

The Congressional Budget Office (CBO) is expected to release a score for the revised bill on Monday or Tuesday.