Motion to Waive All Applicable Budgetary Discipline Re: Amdt. No. 270

Amendment 270 is essentially the Better Care Reconciliation Act (BCRA), version 3 (or 4, depending on how you count them). The BCRA is the legislation that Senate Republicans unveiled on June 22 (the bill number is still H.R.1628, since the legislation began in the House, as the American Health Care Act).

The following week – on June 26 – Senate Republicans published an updated version of the BCRA that incorporated a continuous coverage requirement, which the first version did not have (the continuous coverage requirement would impose a six-month waiting period on anyone obtaining coverage in the individual market after having a gap in coverage of 63 or more days during the preceding 12 months).

On July 13, a third version of the BCRA was released, which incorporated the Cruz Amendment (added by Senator Ted Cruz, of Texas). The Cruz Amendment would allow insurers to sell plans that don't comply with a variety of ACA regulations, as long as they also offer at least one silver plan, one gold plan, and one plan that complies with the BCRA's benchmark standards (provides 58 percent actuarial value, which is equivalent to the most bare-bones bronze plans in today's market).

Amendment 270 was the third version of the BCRA, plus the Portman Amendment. That amendment would provide $100 billion that states could use to reduce out-of-pocket costs for low-income enrollees on private plans, and allow states additional flexibility to use Medicaid funds to offset out-of-pocket costs for low-income enrollees who transition from Medicaid to private coverage under the BCRA.

The final version of the BCRA had not been been made available to the full Senate as of July 25, so much of it was read publicly on the Senate floor.

Ultimately, the bill died on a procedural matter – it didn't meet the requirements for a reconciliation bill. Senator Patty Murray (D, WV) called for Amendment 270 to be stricken due to noncompliance with the Byrd Rule, which governs the budget reconciliation process. Only bills that comply with the Byrd Rule can pass with a simple majority; otherwise, a bill needs a 60-vote majority.

At issue was the fact that neither the Cruz Amendment nor the Portman Amendment had been scored by the CBO, which is a requirement for a reconciliation bill. In addition, there were a variety of other aspects of the BCRA that the Senate Parliamentarian had already said would not comply with the Byrd Rule, and two additional parts of the bill – the 5:1 age rating rule and the small business "association health plans" – were declared noncompliant with the reconciliation procedure the day before the vote. Senator Mike Enzi (R, WY) put forth a motion to waive the Budget Act and allow Amendment 270 to proceed despite not conforming to the Byrd Rule, but the motion failed, 43-57, 43-57. As a result, Amendment 270 could not proceed.

The Senate's 46 Democrats and 2 Independents (who caucus with the Democrats) all voted against the motion to waive the Budget Act (in essence, this was a vote against the BCRA). They were joined by nine Republican Senators: Susan Collins (Maine), Bob Corker (Tennessee), Tom Cotton (Arkansas), Lindsey Graham (South Carolina), Dean Heller (Nevada), Mike Lee (Utah), Jerry Moran (Kansas), Lisa Murkowski (Alaska), and Rand Paul (Kentucky).

Why supporters pushed for this bill

• Amendment 270, ie, the BCRA plus the Cruz Amendment and the Portman Amendment, is essentially a bill to repeal and replace various provisions of the ACA. Since ACA opponents have spent seven years pushing for repeal, many of them are eager to pass any legislation that would accomplish that.
• The Cruz Amendment and the Portman Amendment had been added to the legislation in an effort to garner support from both ends of the political spectrum: The Cruz Amendment generated some support among conservatives who want to see fewer regulations on insurers, and the Portman Amendment may have swayed some moderates who were concerned about the BCRA's impact on out-of-pocket costs for lower income Americans (Senator Shelley Moore Capito supported Amendment 270 because of the Portman Amendment).

Why opponents tried to stop the bill

• Democrats universally opposed Amendment 270. Although the CBO had not scored the Cruz Amendment or the Portman Amendment, their scoring of the previous version of the BCRA projected that the bill would result in 22 million additional uninsured Americans by 2026.
• Because the BCRA uses a benchmark plan with 58 percent actuarial value (as opposed to 70 percent under the ACA), the coverage that people would get would be much less robust. The CBO projected that individual deductibles for benchmark plans would be roughly $13,000 by 2026 – clearly an unaffordable amount for low-income and moderate-income households. The Portman Amendment would presumably have helped to reduce this somewhat (although that funding was only designed to last for seven years), but the CBO wasn't given time to score the Portman Amendment, so we don't know what the effect would have been. All told, opponents of the BCRA were concerned that out-of-pocket costs would be far too onerous if the legislation were to be enacted.
• The BCRA would have cut Medicaid by $756 billion over the next decade according to the July 20 CBO report. Democrats and moderate Republicans in the Senate were opposed to the Medicaid cuts, as they would result in states having to cut benefits, eligibility, or both.
• As noted above, Amendment 270's noncompliance with the Byrd Rule was an insurmountable obstacle.
• Some of the opposition to the BCRA (and thus Amendment 270) was from conservatives who believe that it doesn't go far enough in terms of repealing the ACA. In general, they preferred the "repeal and delay" measure (H.R.3762) that passed in 2015 but was vetoed by President Obama. Senator Jerry Moran (Kansas), Senator Mike Lee (Utah), Senator Bob Corker (Tennessee), Senator Lindsey Graham (South Carolina), Senator Tom Cotton (Arkansas), and Senator Rand Paul (Kentucky) were in this camp.
• Among the American public, the BCRA had very little support, polling at just 17 percent approval in June.

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