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The Prognosis for Healthcare Reform in 2017

The Prognosis for Healthcare Reform in 2017

On June 22, the Senate released a draft of the Better Care Reconciliation Act (BCRA) and designated it as fast-track legislation, meaning that no committees will hear it and there will be no public hearings. This bill is not an amended version of the AHCA, it is an entirely separate bill and it is more moderate in key areas (more on this later) than the AHCA. Check out NAHU’s comprehensive review of what’s in and what’s out of the BCRA. Setting aside the contents of the bills, here’s a look at the process and likelihood that either one or some combination of the two will pass.

It’s likely the Congressional Budget Office will “score” the draft BCRA and that the Senate will have only a day or two to consider that score before being asked to vote on it. This forced march to a vote will clearly disturb undecided Senators. All this is expected to occur during the week of June 26, just before the Independence Day recess. Just as the House Speaker, Paul Ryan, had to thread a very fine needle to pass the AHCA, Mitch McConnell, Senate Majority Leader, will have to navigate the BCRA through a minefield of conflicting interests from very conservative to more moderate Republican Senators in order to secure the 50 votes (assuming VP Mike Pence casts the tie-breaker) needed to pass the bill. In fact, he cannot lose more than two Republican votes and hope to pass it, assuming all Democrats vote against.

On June 23, at least five Republican Senators came out against the BCRA and another four have expressed strong concerns with various elements of it. Given the condensed schedule there will be limited time in which to sway seven of those nine in favor, making passage very challenging. However, let’s make the assumption that McConnell succeeds and the BCRA is passed. What happens next? Since there would be two healthcare reform bills, the Senate’s more moderate BCRA and the House’s more conservative AHCA, focus would return to the House, which could:

  • Pass the BCRA – not likely since its provisions are not in line with those of the AHCA.
  • Ignore it, amend the AHCA and send that back to the Senate – also not likely since it will probably not appeal to the more moderate Senate.
  • Send it to conference committee, where legislators from both houses attempt to work out differences and then have each chamber vote on the consensus bill.
  • Suggest that the leaders of each chamber work out differences outside of a formal committee and then present a consensus bill on which both chambers can vote.

Time, or the lack of it, is a crucial factor in this process. The House and Senate must conclude the debate and vote on a healthcare reform measure, or pull it from consideration if there is not enough support, very soon so that they can move on to other business. The AHCA passed by a razor-thin margin, mostly because the more conservative wing of the Republican party did not think it went far enough to replace the ACA. It’s hard to imagine the more moderate BCRA or an amended, more moderate version of the AHCA garnering enough votes for passage in the House.

The bottom line is that with the release of the draft BCRA, healthcare reform is only marginally closer and even that is not assured.

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