ACA ‘repeal-and-delay’ bill fails in Senate as industry worries about ‘skinny repeal’

As part of the Senate’s flurry of action on proposals to repeal and/or replace the Affordable Care Act, Republicans brought up the same bill to get rid much of the law, without a replacement ready, which had passed through Congress in 2015. This time, it failed, with seven Republicans and all Democrats voting against it.

Alternatively called a “clean” repeal bill or “repeal-and-delay,” this legislation would’ve left some parts of the ACA in place, such as much of the law’s insurance regulations. The individual and employer mandates would’ve been eliminated immediately, while keeping the subsidies for buying insurance and Medicaid expansion for two years to allow time for a replacement plan to be crafted.

It had been the favored strategy of Republicans for several months after President Donald Trump’s victory in the 2016 election. After studies estimated the bill would result in 32 million fewer people being insured by 2026, 25 percent higher premiums in 2018 and a $1.1 trillion increase in uncompensated care costs at hospitals, it was abandoned for legislation simultaneously repealing and replacing the ACA. The result of those efforts in the Senate—the Better Care Reconciliation Act (BCRA)—was rejected in a Tuesday night vote by an even wider margin.

Sen. Susan Collins, R-Maine, was one of the few Republican “no” votes on the 2015 repeal bill, and she opposed it again on Wednesday. The six other Republican senators who voted against it—Dean Heller of Nevada, Lisa Murkowski of Alaska, Lamar Alexander of Tennessee, Shelley Moore Capito of West Virginia, John McCain of Arizona and Rob Portman of Ohio—had all voted “yes” on the 2015 bill when it was assured to be vetoed by then-President Barack Obama.

The idea had long been opposed by most major healthcare groups, but those organizations were more focused on an idea which may be able to gain the support of 50 Republicans: a so-called “skinny repeal” bill. This legislation would eliminate the ACA’s individual and employer mandates, as well as the medical device tax, while leaving the rest of the law’s subsidies and insurance regulations in place. This would likely result in a “death spiral” on the individual market as healthier, younger customers would no longer be penalized for going uninsured, and drive up premiums.

“Eliminating the mandate to obtain coverage only exacerbates the affordability problem that critics say they want to address,” American Medical Association President David Barbe said in a statement. “Instead, it leads to adverse selection that would increase premiums and destabilize the individual market.”

The Blue Cross Blue Shield Association said any legislation which eliminates the ACA mandates has to “include strong incentives for people to obtain health insurance and keep it year-round” to keep premiums down.

Passing a “skinny” bill wouldn’t be the end game, according to several Republican senators. Instead, its seen as a way to move onto a conference committee with the House to negotiate an entirely different ACA repeal plan, though it’s possible the House could just pass the bill as-is.

“It’s a vehicle to get us into conference,” Sen. Lindsay Graham, R-South Carolina, told the Independent Journal Review. “That is not a solution to the problem.”