Senate Considering Three Different Obamacare Repeal Bills

We break down what the competing plans might mean for people with diabetes.



Analysis

On July 18th, I wrote a headline that I thought was pretty safe: “The Senate Health Bill is Dead.” The night before, Republican leadership in the Senate admitted that they lacked the votes needed for a procedural move necessary to pass the Better Care Reconciliation Act (BCRA). Headline tied it up in a bow, right?

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That headline might become Insulin Nation’s version of “Dewey Defeats Truman.” Multiple news outlets are reporting that next week Republicans might vote on several competing bills to repeal and replace the Affordable Care Act, including BCRA. Senator Rand Paul (R-KY) suggested that Republican leadership should just draw names of bills out of a hat to see which to vote on first; no one really knows if he’s joking.

Okay, before we proceed, I want you to look up and see the word “analysis” at the top of this article. Why did I put that there? Because what I’m about to share can’t really be characterized as news; it’s closer to speculation. Everyone is confused about what bills will be voted on, if any, next week, and President Trump has sent conflicting signals of what he wants done in a matter of hours.

Covering such evolving news can be very tricky, as summed up by this tweet exchange between a communications director for a Republican senator and a reporter from Axios:

Near as I can figure, there are three possible Obamacare repeal bills that could be voted on in the Senate, if you don’t count the Affordable Health Care Act (AHCA) that already passed the House of Representatives. I’m going to try and boil them down to what they mean more for people with preexisting conditions like diabetes, even though one could write a book about how each would fundamentally change healthcare in the United States.

For this brief summary, I lean almost completely on an informative chart produced by NPR. Two caveats: all three would likely reduce the number of people covered on Medicaid over time, and all three mainly focus on people who get insurance on the individual market, not those who get their insurance through an employer.

The bills are:

The Better Care Reconciliation Act

There are two drafts of this bill that have been discussed, with the newest draft of this bill not including the so-called Cruz amendment. This amendment would allow insurers to sell plans that lacked essential health benefits. BCRA is the bill they couldn’t muster the votes for last week.

For people with diabetes: The current version allows states to ask for permission to drop some of the essential health benefits insurers must provide. If one of those benefits includes drug coverage or coverage for diabetes, then that will jack up prices for people with diabetes. Insurers could theoretically then also impose annual or lifetime caps for coverage on the eliminated benefit.

Patient Freedom Act of 2017

The least discussed option of the three, it’s being championed by two Republican senators who are from states which trend older and lower-income than the national average.

For people with diabetes: It eliminates the individual mandate for coverage, which would likely raise premiums once healthy, younger customers flee the market. The bill keeps the ACA provision requiring insurers to cover people regardless of preexisting conditions, but it does away with the requirement of essential health benefits, so there’s more chance people with diabetes will end up paying more for health care than under the ACA. The bill is unique in that it allows states to re-adopt the ACA or come up with their own health plan regulations (albeit with less or no money from the federal government.)

The No-Name Straight-up Repeal of the Affordable Care Act

Okay, this isn’t this plan’s official name; right now, the plan doesn’t have a name. The proposed legislation is a rehash of a 2015 plan most Republican lawmakers backed that would have repealed Obamacare with a two-year sunset for getting a new plan in place.

For people with diabetes: This plan basically hits the reset button to insurance regulations before Obamacare, meaning there would be no individual mandate and no subsidies for coverage. However, this new version differs from the 2015 plan in that it keeps the essential health benefits standard and the provision requiring insurers to cover people with preexisting conditions at the same cost as those without preexisting conditions. The concern is that healthy people will flee the insurance marketplace under this plan, causing prices for plans to rise at a time when subsidies have been eliminated.

Now here’s the part of the article where I tell you the likelihood of these bills passing or coming to a vote, but, frankly, I give up. Conventional wisdom in D.C. says that none of these bills have the votes needed to pass, but if so, then why are Republicans in the Senate pressing ahead with a vote next week? The best we can say is that the situation remains fluid.

So why bring this up at all until we know for sure what’s happening? Because the uncertainty itself is enough to make all health care industry watchers hold their breath, and because if anything happens, it will happen quickly. Whenever we learn something new about the fate of any of these bills, we’ll update you as quickly as we can on Twitter @InsulinNation.

7/24/2017 – This article has been corrected to include the fact that BRCA has two different proposed drafts – one with the Cruz amendment and one without. 

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Craig Idlebrook is chief editor for Insulin Nation and Información Sobre Diabetes, and was founding editor for Type 2 Nation. You can reach him at cidlebrook@selfrx.com.