The Republican leadership’s plan to repeal and replace Obamacare
— or just repeal it, depending whom you ask — ended the week
in a state of flux that has left more questions than
Consider what has happened just since Monday. Two plans have
seemingly fallen apart, then been at least partially revived. The
Congressional Budget Office issued scores on two different bills.
And President Donald Trump adjusted his desired outcome for the
debate three different times.
One thing is clear, however: The Better Care Reconciliation
Act (BCRA), the GOP bill to repeal and replace the law known as
Obamacare, does not appear to be any closer to passage than it
was at the start of the week.
On Friday, after a week of twists and turns, the BCRA got
more bad news: The Senate parliamentarian ruled that many of its
key provisions, under Senate rules, would require 60 votes
to pass. That will likely mean some provisions aimed at
enticing Republican members will need to be stripped from the
“This will greatly tie the majority leader’s hands as he
tries to win over reluctant Republicans with state-specific
provisions,” Senate Minority Leader Chuck Schumer said. “We will
challenge every one of them.”
What is the plan?
Led by Senate Majority Leader Mitch McConnell, Republicans
appear to be pushing two different plans.
One is the BCRA, which would repeal Obamacare and
immediately replace it. It’s the plan that the GOP conference has
been haggling over for the past several weeks.
The legislation appeared to be no longer
viable as of Monday, when two more Republican senators said
they would not vote for a key procedural vote to bring it to
the floor. It meant four GOP defections from the
legislation, two more than leadership could afford to move the
The other plan is the Obamacare Repeal Reconciliation Act
(ORRA), which would repeal Obamacare with a two-year delay with
no immediate replacement. McConnell said the delay would
give enough time for Congress to come up with a replacement
Leadership and rank and file Republicans so far haven’t
confirmed which of these plans is going to be advanced to a vote,
but they’re targeting movement next week.
What would be the effect of the plans?
Coverage: The ORRA would result in 32
million more uninsured Americans by 2026 than under the current
system. That number is 22 million under the BCRA.
Premiums: With no replacement, average
premiums in the individual market would double by 2026 under
the ORRA. Under the BCRA, premiums would decrease by 30%, but
out-of-pocket costs would soar for older and sicker
Deficit reduction: The ORRA
would lead to $473 billion in deficit savings for the
federal government through 2026. The BCRA would result in $442
billion in savings over the same timeframe. Most of the savings
would come from cuts to the federal Medicaid program.
The CBO’s score of the BCRA did not include a key
provision advanced by Sen. Ted Cruz. The Consumer Freedom
amendment would allow insurers to sell plans that do not
abide by two major Obamacare regulations. H
experts say the provision could
undermine protections for people with preexisting conditions
and cause trouble in the individual insurance market.
Are there enough votes for either plan?
It doesn’t seem that way.
On Wednesday night, Republican senators held an
emergency meeting and left without a
Additionally, neither Sen. Susan
Collins nor Sen. Rand Paul were present at the meeting. Both
Republicans have been vocal in their distaste for the BCRA in
all of its iterations so far.
In terms of the repeal and delay plans, it doesn’t seem
that the three senators who opposed it on Tuesday — Collins, Lisa
Murkowski, and Shelley Moore Capito — have changed their
opinion in the interim. Additionally,
reports have indicated that many more members could
vote against the plan if it got to the floor.
The advancement of two different plans does seem to have
caused some confusion among the conference, but it appears
the primary goal is trying to find a deal on the BCRA.
Complicating factors is the absence of Sen. John McCain,
who announced his brain cancer diagnosis on Wednesday night.
McCain promised to return to the Senate soon, but it’s
While it is a difficult situation,
there is also the political reality that any healthcare plan can
only lose a single vote in order to pass now. This makes passage
even more improbable.
Sen. John Cornyn, the second-highest ranking member of the
GOP leadership, has said senators will take a key procedural vote
early next week. Also on Thursday, Sen. John Thune, another
member of the leadership, was asked
by reporters which plan would be introduced after the
“Who knows?” he said.