Editor’s Note: This post will be continually updated as debate in the Senate continues on July 27. 

Update July 28, 1:41 am: After a vote to commit the bill to the HELP committee failed 48 to 52, the Senate voted on the HCFA. The vote failed 51 to 49 as Senators Collins, McCain, and Murkowski joined all 48 Democrats in voting against the bill. Senator McConnell then stated that it would be returned to the calendar, meaning it can be brought back, but consideration then ends for tonight.

Original Post

At 10:00 p.m. on July 27, 2017, Senator McConnell introduced amendment 502, his Health Care Freedom Act. The bill is indeed skinny, only eight pages in length. It would:

  • Repeal the individual mandate penalty effective December 31, 2015;
  • Repeal the employer mandate penalty (but not reporting requirements) effective December 31, 2015, but only through 2024;
  • Extend the moratorium on the medical device tax from December 31, 2017 to December 31, 2020;
  • Increase maximum contributions to health care savings accounts (HSA) to the amount of the deductible and out-of-pocket limitations for HSA-eligible high-deductible health plans ($6,650 individual, $13,300 families for 2018) for three years, 2018 to 2020;
  • Ban payments for one years to Planned Parenthood and any Planned Parenthood-like organization (the CBO says there is one) that received federal and state payments in 2014 that exceeded $1,000,000;
  • Repeal the Prevention and Public Health Fund after 2018;
  • Increase Community Health Center Funding by $422 million for 2017;
  • Amend ACA section 1332, which governs state innovation waivers to:
    • Add $2 billion to pass through funding for states that submit and implement state innovation waivers;
    • Provide that HHS and the IRS “shall” instead of “may” approve a 1332 waiver if (not “only if” as in the current legislation) the secretaries determine that the application meets the benefit comprehensiveness, cost sharing, enrollment, and budget neutrality guardrail requirements;
    • Require a secretarial determination within 45 instead of 180 days;
    • And extend waivers from 5 to 8 years with unlimited renewals for 8 year periods and no cancellation by the secretaries. (This could mean that once a waiver is approved, there is no way that the federal government can ensure that a state complies with its terms);
  • The ACA provisions that can be waived are the same as those that can currently be waived, including: 
    • essential health benefit requirements (but coverage has to be at least as comprehensive as the essential health benefit requirements as certified by the CMS chief actuary),
    • cost sharing limits in the individual and small group market,
    • actuarial value requirements,
    • abortion restrictions on qualified health plans,
    • exchanges,
    • the single risk pool,
    • the requirement that Congress receive its coverage through the marketplace,the premium tax credits, and
    • the cost-sharing reduction payments.

The legislation makes no changes in Medicaid or CHIP and repeals no other taxes. It has presumably been cleared by the Parliamentarian for Byrd compliance. The CBO has scored the bill as reducing the deficit by $135.6 billion, barely squeezing by the $133 billion target they had to hit to reduce the deficit as much as the House American Health Care Act. The CBO has also scored the bill  as increasing the number of uninsured by 15 million and increasing premiums for policies in the individual market by roughly 20 percent relative to current law in all years between 2018 and 2026.

The Senate is now debating a Democratic motion to commit to the HELP committee. If the motion fails, and the bill passes, it will go to conference with the House, although the House could simply adopt it and send it to the President. The House could also reportedly adopt the skinny bill and send it to the President if the bill goes to conference committee and the Senate fails to adopt conference amendments. The Senate will next vote on the motion to commit and then on the amendment itself. But a couple of hundred amendments have been filed and it could still be a long night.