The latest iteration of the GOP effort to repeal and replace the Affordable Care Act, released this morning by Sen. Mitch McConnell, R-Ky., includes provisions designed to win over both conservative and centrist GOP members of the Senate.

The first version of the Senate legislative draft, released last month, was pulled before a vote was taken, with 10 or more senators at the time likely to oppose it.

“The debate continues,” said Nicole M. Elliott, former IRS senior advisor for the Affordable Care Act and lead executive responsible for overseeing all aspects of the Affordable Care Act implementation.

“The Medicaid provisions that were in the prior bill are the same,” said Elliott, a partner at Holland & Knight.

“In terms of taxes, it retains the ACA taxes on high net worth individuals, which was a major sticking point for some,” she said. “It allows HSAs [health savings accounts] to be used for premiums, which is a major change, and it allows individuals to use tax credits for catastrophic coverage. Importantly, it includes the Cruz-Lee amendment, which allows issuers to offer plans that don’t meet ACA market reforms, so long as they offer one plan that does. This means that insurers could market much skinnier plans than currently allowed.”

“We’ll see a revised CBO [Congressional Budget Office] score next week, and then a vote,” she said.

“These are provisions designed to move the needle toward a yes vote, but its fate is still unknown—it will be close,” she predicted.

Senate Majority Leader Mitch McConnell, a Republican from Kentucky, center, walks to a private GOP meeting at the U.S. Capitol in Washington, D.C.,  on the day of the unveiling of the GOP health care bill
Senate Majority Leader Mitch McConnell, a Republican from Kentucky, center, walks to a private GOP meeting at the U.S. Capitol in Washington, D.C., on the day of the unveiling of the GOP health care bill Andrew Harrer/Bloomberg via Getty Images

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Roger Russell

Roger Russell

Roger Russell is senior editor for tax with Accounting Today, and a tax attorney and a legal and accounting journalist.