Capitol Hill Healthcare Update May 23, 2017

CBO Score of House Health Bill Set for This Week

Congress's official budget scorekeepers this week will release analysis of the House-approved bill repealing most of the Affordable Care Act (ACA), and that data will inform Senate Republicans on a path for passing their version of the legislation.

The Congressional Budget Office (CBO) and the Joint Tax Committee on Wednesday are scheduled to release analysis - known on Capitol Hill as a "score" - of the House bill, including how much the bill reduces government spending and revised projections of how many Americans could lose insurance coverage.

Under Senate budget rules, that chamber's bill must reduce spending by at least as much as the House's bill. That may create complications for senators who want to provide more generous tax subsidies for people who buy insurance or if the lawmakers want to keep the ACA's Medicaid expansion. Senate Republicans could get around increases in spending by phasing in changes or delaying the repeal of some of the ACA provider taxes and fees - though each of those decisions would provoke other political complications.

Senators met several times last week to discuss next steps on Medicaid, as well as helping insurers offer coverage for pre-existing conditions and creating a short-term fix to stabilize the individual insurance markets. But once they have the CBO score, the Senate GOP's pathway for what can be accomplished politically will become clearer.

Finance Committee Chairman Orrin Hatch (R-Utah) earlier this month wrote to trade associations representing patients, providers and employers seeking feedback on provider taxes, Medicaid, tax credits to purchase healthcare coverage, and funding to stabilize states' individual markets. Hatch asked for responses by Tuesday.

Several Senate Democrats last week said they have had discussions with Republicans about policies they could support in ACA legislation. Despite those attempts at bipartisanship, the healthcare overhaul is likely to remain an all-GOP exercise under the budget reconciliation process, which requires only a simple majority to win Senate approval.

While Democrats would vote for legislation that fixes some of the ACA's shortfalls, they will not support repealing the healthcare law, even in part. Moreover, giving Democrats an opportunity to shape the healthcare bill would run counter to the Senate GOP's political interests, even with President Trump's current political troubles. That's because 10 Democrats face re-election in 2018 in states Trump won, and GOP leaders don't want to give those Democrats bipartisan bona fides ahead of their races.

Some conservative senators - including Sens. Ted Cruz (R-Texas) and Rand Paul (R-Ky.) - said last week that the CBO score and budget reconciliation rules are effectively a legislative straitjacket on Congress. Both senators called for changing Senate rules to allow simple majorities to approve legislation and for overriding rulings from the Senate parliamentarian on what qualifies under a budget reconciliation bill - but GOP leaders said they have no intention of rewriting the...