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The Senate’s expected to vote on a health care bill this week, though which bill they will vote on is still unknown.
They’ve got three options:
1) The Senate’s plan to repeal and replace the Affordable Care Act (better known as Obamacare).
2) A plan to strictly repeal Obamacare.
3) The House of Representative’s plan to repeal and replace Obamacare.
It’ll start with a motion to proceed on Tuesday, that will open up 20 hours of debate before the Senate begins to vote.
Here’s how Republican Senator Susan Collins put it on Face the Nation on Sunday:
“It appears that we will have a vote on Tuesday. But we don’t whether we’re going to be voting on the House bill, the first version of the Senate bill, the second version of the Senate bill, a new version of the Senate bill, or a 2015 bill that would have repealed the Affordable Care Act now, and then said that somehow we will figure out a replacement over the next two years.”
“I don’t think that’s a good approach to facing the legislation that affects millions of people and one-sixth of our economy.”
Here’s what you need to know about the bills the Senate could consider.
Better Care Reconciliation Act, or repeal and replace (with or without the Cruz amendment)
On Thursday, Republicans in the Senate just released another update to the Better Care Reconciliation Act, or BCRA, their plan to repeal and replace Obamacare.
This is the effort that ran into trouble last week after Senator John McCain fell ill and some other Republicans declined to go along with the vote.
The latest draft of this bill includes more funds to tackle the opioid crisis, and a change to allow people to pay for premiums using health savings accounts. The bill also still includes deep cuts to Medicaid, with an estimated $756 billion cuts by 2026 according to the Congressional Budget Office.
But notably absent is an amendment from Senators Ted Cruz and Mike Lee that critics said could make plans with adequate coverage unaffordable to those who have certain medical conditions.
The amendment titled the “Consumer Freedom Amendment,” would have allowed plans to exist that don’t comply with two regulations set up under the Affordable Care Act: community rating and essential health benefits. The latter could have had a big impact on people with pre-existing conditions.
Key parts subject to Byrd rule: On Friday, the Senate parliamentarian said that major parts of the BCRA would be subject to the Byrd rule, an obscure piece of legislation that requires the bill to have 60 votes in its favor to avoid a filibuster. Any other legislation would simply need 50 votes. Included in the list of provisions subject to the Byrd rule are defunding Planned Parenthood, restricting the use of tax credits for abortions, and getting rid of the essential health benefits for Medicaid in 2020.
CBO’s conclusion: The bill, without the Cruz amendment, would leave 22 million more Americans without insurance by 2026 compared with the current law, in line with their estimates for the original bill. That number likely would have been inflated if the CFA was included. The CBO also said the bill would have an unexpected effect on deductibles: they could get so high they’re actually more than the poorest Americans earn. The bill would cut $756 billion from Medicaid through 2026.
The Obamacare Repeal Reconciliation Act or straight repeal
Senate Republicans are also mulling over a plan to simply repeal the Affordable Care Act. Titled the Obamacare Repeal Reconciliation Act (ORRA), it is nearly identical to the bill that was vetoed by President Barack Obama in 2015. The bill would repeal all the provisions put in place by the ACA, including key taxes, the Medicaid expansion some states opted into and getting rid of mandates for employers and individuals to provide and have insurance.
The repeal would begin in 2020.
CBO’s conclusion: According to the agency, 17 million fewer Americans would have health insurance in 2018, a number that would grow to 32 million by 2026. By 2026, health insurance premiums are expected to double. Cuts to Medicaid would hit $842 billion by 2026.
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The American Health Care Act
There’s also still the chance that the Senate could decide to vote on the AHCA, the version of repeal and replace that the House of Representatives passed in May.
Among other provisions, the bill included a change called the MacArthur amendment which can allow states to avoid some of the regulations. It raised concerns that people with preexisting conditions won’t be able to access health insurance if it becomes law.