US Senate Republicans to release healthcare bill Thursday

On June 22, 2017, Senate Republicans under Majority Leader Mitch McConnell prepared to release their long-awaited draft legislation to repeal and replace the Affordable Care Act. The bill, formally titled the Better Care Reconciliation Act of 2017 (BCRA), was the culmination of weeks of private negotiations among a small group of Republican senators, a process that drew criticism for its lack of transparency.

After the House of Representatives passed its own version, the American Health Care Act (AHCA), the month prior, the legislative effort moved to the Senate. The release of the discussion draft was the first opportunity for the public, and for most senators, to see the specific legislative text intended to reshape a major part of the U.S. economy.

A Contentious and Secretive Process

The drafting of the bill was conducted almost entirely in private, a strategy that generated significant opposition from Democrats and expressions of concern from some Republicans. Democratic leaders condemned what they described as an attempt to rush a major piece of legislation to a vote without public hearings or committee markups. Speaking on the Senate floor, Democratic Leader Chuck Schumer criticized McConnell for planning to allow only ten hours of debate on a bill affecting millions of Americans.

Some Republican senators also voiced reservations about the process. Marco Rubio of Florida was reported at the time to have warned that it would be a problem if the bill were rushed from a small group directly to a floor vote without adequate time for review. The secrecy meant that key moderate senators like Susan Collins of Maine and Lisa Murkowski of Alaska, whose votes were considered crucial for passage, were not part of the core working group that wrote the bill.

Key Provisions of the Draft Bill

The Senate draft departed from the House-passed AHCA in several significant ways. It was structured to provide tax credits based on income, age, and geography, similar to the Affordable Care Act, but they were generally less generous. A central component was its handling of Medicaid. The bill proposed to phase out the ACA’s enhanced federal funding for Medicaid expansion over a period of three years, a slower timeline than the House bill but one that still caused concern for Republican governors and senators from expansion states like Rob Portman of Ohio, who had reportedly sought a seven-year phase-out.

The BCRA also aimed to repeal most of the ACA’s taxes and eliminate the individual mandate, which required most Americans to have health insurance or pay a penalty. Unlike the House bill, the Senate draft did not include waivers that would allow states to let insurers charge higher premiums to people with pre-existing conditions, a provision that had been highly controversial.

Democratic Opposition and Republican Divisions

Democrats were united in their opposition, arguing that the bill’s deep cuts to Medicaid would harm vulnerable populations and that the changes to subsidies would make insurance unaffordable for many older and lower-income Americans. Senator Chris Murphy of Connecticut described the draft as “morally bankrupt.”

Within the Republican conference, McConnell faced a difficult balancing act. He could afford to lose only two of the 52 Republican senators for the bill to pass. The party was split between a conservative faction that felt the bill did not go far enough in dismantling the ACA, calling it “Obamacare lite,” and a moderate wing worried about the impact of Medicaid cuts and the potential for millions to lose coverage. The release of the text was intended to begin the process of winning over these skeptical members ahead of a planned vote.

An Uncertain Path Forward

As the draft was released, its future was highly uncertain. Reports at the time suggested that the documents McConnell planned to distribute might include optional approaches on contentious issues, indicating that a final consensus had not yet been reached. The central challenge was crafting a bill that could satisfy both conservatives demanding a full repeal and moderates from states that had benefited from the ACA’s Medicaid expansion.

The Congressional Budget Office was expected to release its analysis of the bill’s fiscal impact and effect on insurance coverage in the following days, a report that was anticipated to be a critical factor in swaying undecided senators. The debate over the bill’s contents was just beginning, with its passage far from guaranteed.

Questions about this record