Senate GOP to Push with Obamacare Repeal Despite BCRA Failure: Public Health Watch Report

As most observers predicted within moments of its introduction, the new Senate healthcare bill released last week has died on the vine—even before it was formally put forward for deliberation and vote.

Dubbed the ‘Better Care Reconciliation Act’ (BCRA) by its chief architect, Senate Majority Leader Mitch McConnell, the bill was essentially seen as a nonstarter by many in and around Capitol Hill. Although it would have achieved the Republican Party’s stated goal of repealing and replacing the Affordable Care Act (ACA; also known as “Obamacare”)—one of President Trump’s key campaign promises—the new iteration of the American Health Care Act (AHCA) approved by the House of Representatives and taken up by the Senate in May did not do enough to mollify conservatives concerned about government spending or moderates who don’t feel comfortable about returning tens of millions of Americans to the ranks of the uninsured so close to the mid-term elections of 2018.

The nonpartisan Congressional Budget Office’s (CBO) scoring of the original bill estimated that as many as 26 million Americans would lose their healthcare coverage within the first 10 years of the passage of the AHCA (the agency did not have the opportunity to score the BCRA). This figure included patients insured under the ACA as well as those on Medicaid, a government program that would have seen significant budget cuts under both the AHCA and the revised BCRA had they been approved.

The Guardian on July 18, 2017 reported that with the defections of Senators Mike Lee (Utah) and Jerry Moran (Kansas), the Republicans lacked sufficient votes in the Senate to approve the BCRA. Senators Susan Collins (Maine) and Rand Paul (Kentucky) had already voiced their opposition to the latest version of the bill last week.

All Democrats in both houses of Congress have indicated that they will oppose any attempt to repeal and/or replace the ACA.

With this latest setback on healthcare, it appears that Republican leaders are taking a new approach. Following a tweet from President Trump suggesting that GOP legislators simply repeal the ACA now, and replace it later, Senator McConnell announced his intention to bring a bill repealing former President Barack Obama’s signature piece of legislation to vote “in the coming days” (per The Guardian). The new bill would repeal the ACA, but provide legislators with a 2-year window to craft a new program to replace it.

President Trump tweeted:

As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!

— Donald J. Trump (@realDonaldTrump) July 18, 2017

However, that plan also appears to face strong opposition within the Republican Party, with Senators Susan Collins and Shelley Moore Capito (West Virginia) already stating they do not support it, according to The Washington Post.

“I did not come to Washington to hurt people,” Capito said on Twitter. “I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.” Her full tweet appears below:

My latest statement on the Senate health care bill & planned vote to repeal Obamacare: pic.twitter.com/yAVIxgptCu

— Shelley Moore Capito (@SenCapito) July 18, 2017

Of course, both the House and the Senate approved bills aimed at repealing the ACA in 2015, when they were both under GOP control, as they are now. President Obama vetoed the legislation, and Republicans lacked sufficient votes in both houses to override the veto. In January 2017, the CBO estimated that 32 million Americans would be left without health insurance should the ACA be repealed, without a replacement.

However, that doesn’t mean that the CBO necessarily advocates for the status quo. In a report released July 18, 2017, the day after McConnell’s announcement dooming the BCRA, the nonpartisan agency noted that, “federal spending on the major health care programs would grow larger than spending in any other category if current laws generally remained unchanged. Driven particularly by growth in Medicare outlays, spending on those programs would account for 40% of federal noninterest spending in 2047, compared with 28% today.” The CBO attributes these rising costs to the aging of the population, among other factors.

The agency also suggests that this rise in costs will only add to the ever-growing national deficit in the United States, estimating that the federal debt could rise to 150% of gross domestic product by 2050, fueled in part by rising healthcare costs.

The report concludes: “Even if future tax and spending policies matched the policies specified under current law, budgetary outcomes would undoubtedly differ from CBO’s projections because of changes in the economy, demographics, and other factors, such as excess cost growth.”

This all adds up to what the reader probably already knows: politicians still have a lot of work to do—regardless of where they stand on the veritable alphabet soup of healthcare laws (both current and proposed) already in circulation.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.