BCRA Fails, Senate Mulls Options

The Senate failed to pass The Better Care Reconciliation Act (BCRA) hours after opening up debate on the bill Tuesday, tanking Republican efforts to replace the Affordable Care Act (ACA) and overhaul the Medicaid program.

The months-long Republican effort still came up 7 votes short, 43-57, with nine Republicans voting no: Susan Collins (Maine), Tom Cotton (Ark.), Bob Corker (Tenn.), Lindsey Graham (S.C.), Dean Heller (Nev.), Mike Lee (Utah), Jerry Moran (Kan.), Lisa Murkowski (Alaska) and Rand Paul (Ky.). All Democrats opposed the bill.

The BCRA contained massive cuts to Medicaid in the form of both per-capita caps based on a significantly stunted growth rate as well as a cut-and-freeze of the provider assessment program.

The reconciliation process through which the bill moved still leaves options open for Republicans who want to repeal parts of the ACA.

Majority Whip John Cornyn (Texas) indicated Republicans will try to pass a smaller repeal and then potentially move to conference with the House. 

“I’d be happy to have a comprehensive bill that 50-plus senators agree to,” Cornyn said. “But if we can’t, then the idea would be to come up with a core of pieces that 50 of us agree on so we can get to a conference.”

Appetite remains among Republicans to do something on health care, but many are unfamiliar with what the end product will look like. Fifty Republicans voted to open up debate on the legislation, a move that allowed leadership flexibility on what ultimately leaves the Senate floor. Collins and Murkowski voted no on the procedural vote, forcing Vice President Mike Pence to break the tie.

The Senate may move soon to vote on a so-called “skinny” repeal, which targets the provisions of the ACA allowable under the rules of reconciliation. Though no text of such a bill currently exists, it is predicted this would also include a two-year delay to allow lawmakers to come up with a replacement plan.

The skinny repeal may also head to conference with the House, in which members from both chambers will be assigned to come to an agreement.

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