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    Four things to watch in Senate Obamacare replacement

    1. Most affected populations. Lower-income individuals who have benefited from Medicaid expansion, either in one of 32 states and the District of Columbia or who received subsidies under the ACA, would be most adversely affected, Sayan says. “Although the BCRA allows for Medicaid expansion to remain for three years, the program would then be phased out and cut substantially,” he says.

    Pipes adds that cost-sharing reduction subsidies, which reimburse insurers for covering certain out-of-pocket expenses for low-income enrollees, will remain in place through 2020, at a cost of about $7 billion a year.

    1. Likelihood of the bill passing. The Senate bill was intended to create legislation that could be more appealing to the moderate wing of the Republican party, and possibly even some centrist Democrats. “In certain respects, the BCRA achieves this through measures including not charging a penalty over lapsed coverage and offering more opportunities for enrollees to take advantage of tax credits,” Sayan says. “However, the steeper cuts to Medicaid could likely make this legislation a non-starter for any Democrat in Congress.”

    Pipes says the Senate bill's passage doesn’t look good as of June 27. “Senators Rand Paul, Mike Lee, Ted Cruz, and Ron Johnson jointly expressed their opposition to the bill within hours of its release,” she says. “Several other Republican senators have been tepid, if not downright cold, to the proposal. Sen. Dean Heller of Nevada, who is up for re-election in 2018, thinks the protections for the Medicaid expansion do not go far enough and is leaning toward not supporting the bill.” On June 26, Sen. Susan Collins of Maine also announced that she could not support the BCRA, stating that it doesn’t fix ACA problems for rural Maine.

    Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.


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