House Passes Big Beautiful Bill; On To The President
After almost collapsing overnight Wednesday in the House, the Big Beautiful Bill gained just enough votes to pass during the afternoon Thursday. The House had to adopt the Senate version to meet the deadline of July 4. Both moderates and conservatives in the House GOP caucus were highly critical of the Senate version, but all but two relented and voted for the budget reconciliation measure. Conservative Thomas Massie, R-KY, and moderate Brian Fitzpatrick, R-PA, were the only GOPers to vote against it. The bill passed 218-214 and the bill will be signed by President Trump tomorrow, Independence Day.
I had always argued there was an inevitability associated with passage of the bill, whatever healthcare cuts are in or the impact on the deficit. The GOP sees the Big Beautiful Bill as a seminal event for the party and a movement. But for a time, the House vote looked very challenging.
Conservatives criticized the massive additional overall deficit and debt the Senate bill generates against the House version. They issued a memo criticizing both the Speaker and Senate Majority Leader John Thune, R-SD, for moving away from the House framework. At the same time, moderates criticized the fact that Medicaid cuts are actually higher than in the House bill, especially as it relates to greater limitations on the provider tax and its phasedown to 3%. Conservatives especially were converted by explanations of the new Senate Medicaid cuts as well as commitments about how certain policies will be implemented by the administration.
Trump, Vice President JD Vance, CMS Administrator Dr. Mehmet Oz, Speaker Mike Johnson, R-LA, and other House GOP leaders are given great credit for convincing the vast majority of the up to 20 GOP holdouts to support the bill. Trump made calls until about 1:00 AM Wednesday night/Thursday morning.
Reductions in healthcare exceed $1.1 trillion. Medicaid cuts center on work requirements, provider tax limitations, and eligibility tightening. Exchange reductions center on eligibility restrictions and tightening. About 17 million could lose coverage from the bill, the expiration of the enhanced Exchange subsidies, and a new Exchange rule just finalized. As I have argued, the reductions are quite stealthy, but the impact will be real.
The healthcare news website Kaiser Health News had two articles on the bill’s impact. Nineteen Medicaid expansion states are led by GOP governors. They have been mum on the potential fallout of the Medicaid reductions, which are very much focused on expansion states. The governors mostly have said they do favor work requirements. But these governors will struggle with the limitations and phasedown of provider taxes used by states to leverage federal match dollars in Medicaid. They will struggle, too, with the additional administrative requirements tied to eligibility and work requirements in both Medicaid and the Exchanges if their states run their own marketplaces.
Actuarial consulting firm Wakely also issued an analysis of the bill’s impact on the marketplace, arguing the future market will look fundamentally different as enrollment declines. Findings include:
- Gross market average premiums could increase between 7% and 11.5% because of market attrition and residual risk pool morbidity increases, not accounting for incremental claims cost trend impacts.
- Enrollment could be reduced by 22% to 27%, or 5.2 to 6.4 million enrollees. This estimate is higher than those of the Congressional Budget Office (CBO). This does not count the impact of enhanced premium subsidy expiration.
Additional articles:https://kffhealthnews.org/news/article/big-beautiful-bill-trump-medicaid-affordable-care-act-cuts-republican-gop-governors/ and https://kffhealthnews.org/news/article/affordable-care-act-aca-obamacare-coverage-gains-threatened-1bbb-uninsurance/ and https://www.fiercehealthcare.com/providers/house-votes-218-214-send-reconciliation-bill-trumps-desk and https://www.medpagetoday.com/publichealthpolicy/washington-watch/116383 and https://www.wakely.com/blog/new-wakely-white-paper-explores-potential-impacts-of-house-reconciliation-bill-on-aca-individual-market-coverage/ and https://thehill.com/homenews/house/5382837-chip-roy-says-senates-medicaid-cuts-a-bit-better-than-expected/?tbref=hp and https://thehill.com/homenews/house/5384637-house-freedom-caucus-opposition-trump-bill/ and https://thehill.com/homenews/house/5383129-house-gop-big-beautiful-bill-trump/ and https://thehill.com/homenews/administration/5384490-trump-big-beautiful-bill/
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#budgetreconciliation #trump #congress #spending #medicaid #aca #exchanges #obamacare #coverage
https://www.modernhealthcare.com/politics-regulation/mh-tax-bill-house-donald-trump
— Marc S. Ryan
