Durbin: Some Republicans waiting on ACA repeal to fail to start bipartisan talks

U.S. Sen. Dick Durbin, D-Illinois, believes opponents of the Senate’s Better Care Reconciliation Act (BCRA) can use a delay in considering the bill to convince undecided Republicans to block it, particularly now that health insurers have come out strongly against the legislation.

At a press conference in Chicago, Durbin called the new version of BCRA just as bad “if not worse,” in his opinion, as other Republican-sponsored plans to replace the Affordable Care Act (ACA). The original timeline for Senate Republicans was to hold a vote on the bill this week, but plans were derailed due to Sen. John McCain, R-Arizona, being absent after having a blood clot removed from above his eye.

Part of that fast-track plan may have involved skipping a Congressional Budget Office (CBO) score. The CBO has analyzed several repeal-and-replace plans in recent months, estimating each to result in between 22 and 24 million more people being uninsured and, in some states, destabilizing the individual insurance market. The Independent Journal Review had reported Republicans could instead rely on an analysis from HHS, run by Secretary Tom Price, MD, a vocal ACA opponent. HealthExec asked Durbin whether such a report could be trusted.

“I worry about people who can’t win a ballgame and want to change the rules and that’s what we hear from the Republicans,” Durbin said. “They don’t like the Congressional Budget Office because it continues to tell the American people how terrible the Republican repeal is, so they’ve decided that the problem is not the bill, the problem is the Congressional Budget Office. They’re going to change the rules in terms of how we count those who are affected by this. That, to me, is a terrible thing to do.”

The CBO score is now expected this week, though without an assessment of the amendment from U.S. Sen. Ted Cruz, R-Texas, to allow insurers to sell plans that don’t comply with ACA regulations on required benefits and community rating.

If the report shows a similar impact on the insurance rate as previous bills, however, it could convince one more Republican to publicly declare their opposition alongside Sens. Rand Paul, R-Kentucky, and Susan Collins, R-Maine, which would be enough to block the legislation.

“My prediction is if he loses one, he’ll lose 10,” Durbin said of Senate Majority Leader Mitch McConnell, R-Kentucky, and his Republican majority. “Everyone will scramble to get off the record on this terrible bill.”

A key factor in that decision could be the new opposition from health insurers. Two of the industry’s largest groups, the America’s Health Insurance Plans and the Blue Cross Blue Shield Association, reached their “tipping point” thanks to the Cruz amendment, according to Durbin. In a letter to Senate leaders, the groups called the plan “unworkable in any form” and lead to widespread adverse selection in the individual market.

If the bill is killed, Durbin said his caucus is willing to work on changes to the ACA with Republicans, adding he knows of “two to maybe three” Republican senators who are waiting on the BCRA’s collapse to begin that discussion. When asked on which policy areas Democrats would want to focus, Durbin mentioned pharmaceutical prices as well as efforts to improve the risk pool in the ACA exchange market.

“Those who are signing up for it are older and sicker and more expensive,” Durbin said. “We’ve got to find a way—and there are carrots and sticks that can be used—to bring more people into that insurance pool.”