CHA News Article

CHA Provides Update on Senate Health Care Bill

Senate Republican leaders have promised to release a draft of their plan to repeal, replace and repair the Affordable Care Act (ACA). The measure has been cobbled together in a series of closed-door meetings over the last few weeks, and Majority Leader Mitch McConnell has indicated that he hopes to have a vote on final passage before the Senate adjourns for its July 4 recess. The details of the bill are still vague and could certainly change. The Congressional Budget Office will need to score the bill before it goes to the Senate floor, a requirement that the House of Representatives avoided when they passed their version, the American Health Care Act (AHCA), in early May. Further, the Senate parliamentarian will need to rule on many of the provisions to ensure they are allowed under the rules of reconciliation — the procedure for considering a bill that has specific budget implications and requires only a simple majority. 

California’s Senators Dianne Feinstein and Kamala Harris have indicated strong support for continuing the Medicaid expansion and other coverage benefits that have helped millions of Californians. The latest discussion documents are said to contain the following provisions. 


  • Drastically reduces federal Medicaid spending, similar to the AHCA
  • Uses a lower growth rate for the per capita caps in the AHCA beginning in 2025 with a three-year period to phase out Medicaid expansion
  • Rolls back the ACA’s enhanced Medicaid spending over four years beginning in 2020
  • Permits states to choose the base amount for their per capita caps based on eight consecutive quarters

Market Reforms

  • Does not include the AHCA’s optional waivers but gives greater flexibility to the ACA’s existing state waivers (including the 1332 waivers), and expedites their approval. Provisions of the ACA that could be waived include essential health benefits, definition of a qualifying health plan and actuarial value requirements
  • It appears not to allow waivers to eliminate the ban on charging sick people higher premiums than healthy people, nor for the requirement that insurers sell plans to people with pre-existing conditions, which the AHCA does make waiveable

Tax Credits

  • Scales back the current ACA subsidy structure. It is unlikely that the AHCA provision limiting tax credits for plans that do not include abortion services will pass the reconciliation requirements in the Senate.
  • Includes a stabilization fund, possibly through the Children’s Health Insurance Program, which contains the Hyde amendment, prohibiting funds for covering abortion services