New Iteration of AHCA Released: Public Health Watch Special Report

Over the course of US history, since the first Congress met in the former capital of New York in the 1780s, the legislative process has never been smooth and easy.

Bills proposed by various members of both houses of the legislature rarely, if ever, become laws without first going through a long, drawn-out process—and, thus, many iterations—that frustrates observers and the general public alike. So, while the fact that we are on, at least, the third version of the GOP healthcare bill isn’t, in and of itself, all that unusual, what is odd, even for a signature piece of legislation that will touch the lives of millions of Americans, is the very public nature of the deliberations, and the fanfare that accompanies each new draft of the proposed bill.

Indeed, relatively few laws have been tracked from bill to ratification with such rapt attention—in fact, the notable exceptions may be previous healthcare proposals, including the Affordable Care Act (or “Obamacare”), the very piece of legislation that has been at the very center of this public back and forth, and the one Republicans are so desperate to consign to the scrap heap. In addition, the legislation that created Medicare and Medicaid, in the 1960s, attracted similar scrutiny.

And so, it is with some pause that we weigh in on the Senate GOP’s latest installment of the American Health Care Act (AHCA), which they hope will enable them to “repeal and replace” the ACA. The chances that this is the final draft of the bill—and that it has the support of enough members of the Senate and House of Representatives to pass and become the law of the land—remain slim.

As reported by The Hill this morning (July 13, 2017), Senate Majority Leader Mitch McConnell and his Republican colleagues have written and released a new (and improved?) version of the AHCA that addresses many of the concerns of the conservatives within their ranks, but not those of their moderate counterparts. According to The Hill, support from moderate Republicans in both houses of Congress is likely vital for the AHCA, in whatever form, to be approved.

The latest (and last?) version of the AHCA still calls for significant cuts to Medicaid, starting in 2025, ending the funds for expansion of the program under the ACA in 2024. Notably, though, the new bill includes the so-called “Cruz-Lee Amendment” (named for its authors, Ted Cruz of Texas and Mike Lee of Utah), which would enable insurers to offer plans that do not meet all of the requirements set forth in the ACA, including protection for people with preexisting conditions. The idea is that this will allow insurers to offer cheaper plans to healthier people.

Interestingly, Senator Lee has, The Hill notes, indicated that he was not involved in the drafting of this version of the bill—or his namesake amendment—and that he will need to review the revised text before determining whether he will support it.

In a nod to moderates, The Hill reports, the new version of the AHCA includes $70 billion in funding to help sick people enrolled in ACA plans manage costs, and it adds $70 billion to the $112 billion already earmarked for premium reduction. However, the tax credits offered under the ACA to offset premium costs have been further reduced.

But, although the GOP plans to schedule a Senate vote on the new version of the bill for next week—before the Congressional Budget Office (CBO) will have a chance to “score” it—we still may be no closer to an endgame. As reported in The Washington Post, “centrist” Republican senators Bill Cassidy (of Louisiana) and Lindsey Graham (of South Carolina) introduced their own plan—live on CNN—minutes before Senator McConnell’s press conference. The essence of the Cassidy/Graham proposal is passing the billions of dollars in tax revenue the federal government receives under the ACA back to the states, to help them offset increased healthcare costs.

The competing bills have likely thrown a monkey-wrench into the already-contentious deliberations, even before legislators—and the public—have had a chance to read the latest draft bills.

Within minutes of both plans being announced, there were already influential stakeholders expressing skepticism about the latest round of proposals ever coming up for vote. The American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) tweeted,

GOP #Healthcarebill votes aren't there yet. Keep up the pressure! https://t.co/wjoRcAf0PY via @CNN

— AFL-CIO (@AFLCIO) July 13, 2017

And, the Post, in an editorial, described the new draft as “still an abomination.”

All of which likely means that the GOP will have to go back to the drawing board—again—and that the heated public debate will continue through the rest of the summer, if not beyond.

We’d tell you to stay tuned, but we get the sense you’ll be doing that anyway.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.