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Four Thoughts on the Better Care Act and What’s Next
Posted by Tommy Ratliff on Jun 23, 2017

In light of yesterday’s grand reveal of the “Better Care Reconciliation Act of 2017” (Better Care Act), the Senate Republican’s bill to repeal the Affordable Care Act, we thought we’d share some thoughts on what’s likely to come.

There is an obvious split down party lines

It seems likely that the Better Care Act will receive no votes from Democratic senators. However, there is also a growing divide amongst senate Republicans, not all that dissimilar from the divide we saw amongst GOP in the House as they were initially passing the AHCA. Four GOP senators have already stated contingent opposition to the bill and support from others may quickly wane, likely for different reasons. 

Moderate and conservative Republicans will likely have different reasons to be against the Better Care Act

To moderate Republicans, the Better Care Act may not go far enough to limit negative coverage impacts, especially in relation to Medicaid. Senators who have expressed these concerns include Sen. Lisa Murkowski (Alaska), Sen. Bill Cassidy (Louisiana) and Sen. Susan Collins (Maine).

On the other hand, conservative Republicans may feel that the Better Care Act doesn’t do enough to accomplish their goals of repealing the ACA. Senators on this side of the equation include Sen. Mike Lee (Utah) and Sen. Ted Cruz (Texas), who along with Sen. Ron Johnson (Wisconsin) and Sen. Rand Paul (Kentucky), released a statement on Thursday indicating their unwillingness to vote on the Better Care Act until more negotiation and information has been obtained.

Additionally, Sen. Paul wrote his own ACA-replacement that thus far has not gained much traction, so if action languishes in the Senate, he may try to sway support for the solutions in his bill that the Better Care Act doesn’t address. Last but not least, Sen. Dean Heller (Nevada), up for re-election in 2018, is the only GOP senator to sit in a state won by Hillary Clinton, and announced his opposition to the bill late on Friday afternoon. 

Senate Majority Leader Mitch McConnell can only stand to lose two votes from dissenting party members to pass the bill

When all is said and done, there is likely to be no Democratic support for the Better Care Act, and there exists a real threat for defections from the aforementioned eight Republican senators and possibly others having issue with certain aspects of the bill. Even with the help of a tie-breaker vote by Vice President Mike Pence, McConnell can only stand to lose two Republicans if every other senator votes according to party lines. 

But the outcome will remain murky until the Congressional Budget Office (CBO) scores the language and the impact of the bill’s language is known

The first 24-48 hours of coverage of the bill will be critical, but the real sticking point may be CBO’s score of the legislation, which is expected to be released early next week. GOP leadership hopes to encourage decision-making expediency with a tight turnaround vote aimed before next week’s July 4th recess.  However, CBO’s estimates to the number of people that will lose healthcare coverage, changes to the federal deficit and other potential effects of the Better Care Act will have a huge impact on how the Better Care Act is received by lawmakers, stakeholders and the public.

Stay tuned for more policy coverage on the Evolent blog, coming soon.