Senate expected to vote on single-payer plan, skinny repeal that would end individual, employer mandates

Since getting a narrow victory Tuesday to begin debate on repealing and replacing the Affordable Care Act, Senate Republicans have so far been unsuccessful in getting legislation passed to move forward on a bill.

[Also: Debate begins on health bill after 51-50 Senate vote]

Today, Republicans are expected to bring forward a proposal that reportedly has a good chance of passing, a skinny repeal.

The Congressional Budget Office estimate shows that 16 million more people would lose coverage by 2026 compared to the current ACA under a skinny repeal. Exchange premiums would increase by 20 percent, the CBO said. Federal deficits would be reduced by $142 billion over the next nine years.

The skinny repeal would end the individual and employer mandate, a move that insurers say would upend the stability of the market and increase premiums. But the proposal does not touch Medicaid, which could win over moderates.

[Also: Senate Republicans eye "skinny repeal" option that rolls back individual mandate]

Most Democrats and some Republicans claim numerous Americans would lose coverage by the GOP plan to end Medicaid expansion and to turn the entitlement program into a capped benefit. Under the Republican plan Medicaid funding would go to the states and be capped based on the number of beneficiaries in each state.

The District of Columbia and 31 states have expanded Medicaid benefits, which hospital executives have said has reduced the amount of their uncompensated care. States have the option of keeping Medicaid expansion, minus federal funding.

On Thursday, America's Health Insurance Plans sent a letter to Senate Majority Leader Mitch McConnell and Senate Minority Leader Charles Schumer saying that while the status quo is not sustainable, ending the individual coverage requirement is not the solution to stabilize the market. In fact, it would result in higher premiums, AHIP said.

"The mid-August deadline for finalizing 2018 premiums is rapidly approaching, yet significant uncertainties remain," AHIP CEO and President Marilyn Tavenner said.

AHIP recommends what payers have been fighting to keep, continuation of the cost-sharing reduction payments to insurers that helps drive down deductible and out-of-pocket costs for consumers - or face a premium increase of about 20 percent. Current GOP plans end CSR funding in two years.

AHIP also recommends an elimination of the health insurance tax so that premiums do not increase by 3 percent.

It wants individuals with pre-existing conditions covered, coupled with the individual mandate which would get healthier people into insurance plans. Lack of a mandate would lead to the deterioration of the risk pool, which would increase premiums, AHIP said.

AHIP also recommends a mechanism to stabilize the exchanges for people with serious health conditions to put downward pressure on premiums for everybody.

At 2:15 p.m. the Senate will vote on a single-payer health system, that would make the federal government the one insurer for all plans. The amendment was put forward by GOP Senator Steve Daines of Montana, who opposes his own proposal. Daines said he wanted to see who supports socialized medicine and who doesn't. Vermont Senator Bernie Sanders, an independent who has long called for Medicare for all, has called the move disingenuous and said he would not support it.

[Also: Single payer healthcare proposal introduced in California Senate]

Senate Minority Leader Charles Schumer said Democrats will put forward no more amendments until Republicans come up with a final bill.

Senate Majority Leader Mitch McConnell said under single payer, all decisions would be dictated by the government, at an estimated cost of $32 trillion dollars.

The Senate is expected to take votes through the night in a vote-a-rama on numerous amendments to the House reconciliation bill on healthcare.

Twitter: @SusanJMorse