GOP senators' late-night healthcare meeting produces little; HHS analysis of Cruz amendment raises eyebrows

Mitch McConnell
Senate Majority Leader Mitch McConnell indicated on Wednesday that he will hold a vote on a motion to proceed with healthcare legislation next week. (Gage Skidmore / CC BY-SA 2.0)

With Senate GOP leadership aiming to vote on some form of healthcare legislation next week, Republican members worked late into the evening Wednesday to try to hammer out a deal but seem to have made little progress.

The roughly three-hour meeting was attended by about 20 Republican members as well as Health and Human Services Secretary Tom Price and Centers for Medicare & Medicaid Services Administrator Seema Verma, according to Politico. Not in attendance, though, were either senators Susan Collins of Maine or Rand Paul of Kentucky, two of the original holdouts regarding the Better Care Reconciliation Act (BCRA).

Senators hashed out their varied policy disagreements during the meeting and emerged expressing optimism, according to the article. Still, there appeared to be no major breakthroughs, and with Sen. John McCain now out indefinitely as he is treated for brain cancer, their path to passing a bill gets even more difficult.

"We still have some issues that divide us," Sen. Ted Cruz of Texas said after the meeting, Reuters reports.

The nighttime meeting came in the wake of a lunch earlier in the day in which President Donald Trump urged GOP senators to work through their August recess to pass a bill that repeals and replaces the Affordable Care Act.

Also on Wednesday, Senate Majority Leader Mitch McConnell indicated that he will hold a vote on a motion to proceed with healthcare legislation next week, though it was unclear whether it would be a repeal-and-replace bill like the BCRA or a repeal-and-delay measure.

The Congressional Budget Office (CBO) released a score of a newly released repeal-and-delay bill—called the Obamacare Repeal Reconciliation Act of 2017—on Wednesday night, finding that it would increase the number of uninsured individuals by 32 million and double individual market premiums by 2026.

HHS issues controversial analysis of Cruz amendment

The new CBO score wasn't the only analysis to make its rounds Wednesday, as the Washington Examiner obtained a copy of HHS' preliminary analysis of an amendment to the BCRA proffered by Sen. Ted Cruz called the Consumer Freedom Option. The amendment would allow insurers to sell non-ACA-compliant plans in the individual market alongside more robust ACA-compliant ones.

Two top health insurance lobbying groups have panned the amendment, saying it would create an uneven playing field and further destabilize the individual marketplaces. Yet HHS’ draft analysis found that the amendment would both lower premiums and boost enrollment in the individual market—even for high-risk enrollees. It does, however, also assume that non-ACA-compliant plans would have a rather hefty annual deductible—$12,000.

Furthermore, policy experts were dubious about the report’s methodology.

“There are a lot of things about their assumptions and the basic setup that they don’t explain,” Robert Wood Johnson Foundation Senior Adviser Katherine Hempstead wrote in an email to FierceHealthcare.

For example, she said, it’s unclear what the estimates mean for the “current law” under the “high total/non‐ACA enrollment” and “low total/non‐ACA enrollment” scenarios, since current law would seem to be inconsistent with the high and low scenarios.

Another issue: The analysis uses proprietary estimates for the elasticity of consumers’ demand for insurance plans—in other words, how much that demand is expected to change as premiums change. Most bill-scoring models, Hempstead noted, get their elasticity estimates from results of published analyses and report them.

“Overall, this analysis doesn’t provide readers with enough information about the underlying assumptions, so it is very difficult to assess the validity of the model,” Hempstead wrote.

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