Part 20: Confusion In The Senate: Repealing ACA or Amending the BCRA?

As a new replacement plan for ACA, Republicans Senators are planning to introduce a ‘minimalist ACA repeal’ (and replacement plan) or perhaps, repeal only at this stage. Senators finally realize that passing a comprehensive repeal and replacement bill that needs 60-votes is too challenging and perhaps impossible without buying-in by Democratic Senators. 

This chaos is due to two extreme views held by small groups of Republican senators; and consequent the inability to bring them in census. One group want complete repeal and replacement with a completely new bill. Whereas, another handful of Senators while want to repealing Obamacare, would not support any Medicaid cuts that would affect their own states. Their selfish views put their own electability in 2018 Congressional election first, thus shamefully, preventing putting the country first. 

Different BCRA versions in the Senate: 

At the end of July 2017, while Mitch McConnell manages to overcome the oppositions of seven Republican Senators, two were remained strictly oppose not only the BCRA but also for some 'strange reason', not even allowing it to be debate in the Senate floor. Despite this, with a tie-breaking vote by the vice-president Pence, Republicans managed to get ‘a Healthcare Bill’ to the Senate flow to debate and vote within the next two weeks. 

By the end of last week in July 2017, Republican Senators had two options: complete overhaul of the ACA or taking the ownership of the ACA failure and risking the loss the Senate in 2018 election. With continuous push by president Trump to repeal the Obamacare with or without its replacement, Senators now having second thoughts on how to progress.  

Amending the BCRA:

The Cruze amendment has some merit in paving the path to reducing costs of coverage by allowing to sell plans like catastrophic cover. Rand Paul plan is not clear, except focusing on the importance of the Group insurance plan, as this author have addressed in this series before. On the other hand, the Graham—Cassidy plan would complicate the matter further; giving responsibility for the healthcare (plan) to the Governors of 50-states for them to decide they want to keep he ACA or the replacement plan. Technically this is a non-starter and from its face-value it seems a poorly thought entity. 

Republicans legislators must recognize that Graham—Cassidy, scaled-back plan is not what the American constituents expected. Moreover, this is far away from the campaign promises that Republicans and the president Trump made during their 2016 election campaigns. Thus, it will not achieve neither of these goals. Meanwhile, the Senate is yet to find a comprehensive replacement plan; it comes likely to require 60-votes to enact in the Senate. 

With too many fires are burning, president Trump should have turn over the new healthcare law issue to his conservative ally, Vice President Pence to work with the Congress to persuade his former colleagues to vote for the Bill.  

Baby boomers will further increase healthcare costs it he U.S.A:

During the coming few years, millions of baby boomers will be moving from private health insurance and ACA to Medicare. This will be a great burden on the Medicare system and likely will expedite Medicare’s exhaustion date. In fact, the 2015 Medicare/Social Security Trustees’ Report Analysis reported that combined old-age, survivors, and disability Social Security insurance trust funds will be exhausted in 2034, further unbalancing the overall U.S. healthcare budget.  Funds needing to maintain the Medicare will also increase in parallel.

As they retire, baby boomers will also begin receiving Social Security benefits, which also will have a negative impact on the entitlement systems. Therefore, overall long-term budget planning must consider the effects of these major changes to the national budget estimate and incorporate these inevitable extra expenses into the planning.  

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Professor Sunil J. Wimalawansa, MD, PhD, MBA, DSc, is a physician-scientist, social entrepreneur, process consultant, and educator. He is a philanthropist with experience in strategic long-term planning, cost-effective investments and interventions for preventing non-communicable diseases, globally. 

The author has no conflicts of interest and has received no funding for this work [https://wimalawansa.org; LinkedIn-Wimalawansa]. The author can be reached via [email protected]

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