Senate Majority Leader Mitch McConnell is leading a working group of 13 Senators, including Sen. John Thune, to draft the framework for the Senate’s version of the American Health Care Act (AHCA). However, the group has been waiting for the Congressional Budget Office (CBO) score of the final version of the AHCA that passed in the House 20 days ago. The score will project government savings and estimate how many individuals could become uninsured if the bill were to become law. The House version of the AHCA cut Medicaid by $840 billion, and the number of uninsured would increase by 24 million. The deficit would be reduced by $150 billion over a decade and taxes would be reduced on higher earners by $1 trillion.
The CBO score may prove crucial to the passage of the AHCA. Senate Republican leaders are watching closely not only to see if the AHCA saves money, but to ensure the CBO confirms it hits the $2 billion savings goal (over 10 years) as laid out by the budget committee. This target is important as it will permit the use of reconciliation (the Byrd rule) in the Senate, which allows for bill passage with just 51 votes.
If the CBO score does not confirm the $2 billion in savings, the House would have to vote again on a revised bill that hits that target or forgo the use of the reconciliation process.
For now, House and Senate Republican aides are confident their legislation will meet the goal. An earlier CBO score of the bill showed the legislation saved $150 billion over a decade. However, there is yet another challenge for the Senate with the House version of the AHCA, Republicans can’t just save $2 billion overall. They have to save $1 billion in the Senate Finance Committee and then $1 billion in the Senate HELP Committee.
Lastly, experts have raised questions related to the MacArthur amendment that would allow states to waive certain regulatory requirements under the Affordable Care Act (ACA). If the waiver is adopted by states, the consumer would be able to purchase insurance at a lower price but with less coverage. There is speculation that more consumers would select lower priced policies to be eligible for federal government tax credits under the AHCA. Ironically, this could end up costing the government more money than originally anticipated.
For now, we anxiously await the CBO score and understanding its impact on health care coverage for South Dakotans.