Congress is back in session this week and the Senate will delay their August recess by two weeks as work continues on health care reform. The text of the updated version of the Better Care Reconciliation Act (BCRA) is expected on Thursday and Congressional Budget Office (CBO) score is anticipated next Monday.

With this in mind, Senate Leader Mitch McConnell has said that there will be a vote to advance the bill next week.  However, McConnell’s new timetable may be delayed due to an amendment written by Ted Cruz (TX) and Mike Lee (UT) that would allow the sale of less expensive insurance plans that do not include most of the essential benefits protections contained in the ACA.

The CBO will receive two drafts of the bill text and will be asked to provide two scores. It is unclear if the Cruz amendment will be included in the base bill. Critics of the Cruz proposal argue it would destroy risk pooling for insurers because it would result in healthy individuals pur­chasing skimpy, low-cost plans while those with serious medical or pre-existing conditions would end up in a plan that meets the ACA’s benefit requirements.

In such an environment, sicker people would see their premiums climb sharply over time.  Conservatives also want to expand the use of tax-free health savings accounts, allowing people to use them for monthly pre­miums as well as copayments and deductibles.  Centrist Republicans are concerned about the loss of coverage that would result from the BCRA, especially due to the bill’s deep Medicaid cuts.

Also, the latest draft of the BCRA is likely to keep some of the ACA’s taxes on the wealthy and Medicare to help lower premiums for people with low incomes, provide $45 billion to fight opioid addiction, and allow payment of premiums with pre-tax money.

However, at this time there is no apparent solution for states, like South Dakota that did not expand Medicaid, from the potentially devastating impacts from reductions in coverage and funding through a per-capita cap approach, which will have long-lasting negative impacts on hospitals, doctors, and especially nursing homes and home- and community-based services.

Our primary message remains the same and Senator Thune and Rounds need to hear from you today.  Please contact them through our Legislative Action Center.