The Congressional Budget Office (CBO), will release their updated study of the American Health Care Act (AHCA) the week of May 22. CBO normally would score a bill before the House had voted on it but leadership in the House was in a rush to get a final vote once they had enough to pass the bill. When the score is released the Senate can begin to move on actual language of a repeal bill and they started that discussion this past week.

Despite some political predictions that the Senate cannot get to the 50 votes they need and that any Senate bill could never get enough Republican votes in the House, the vote in the House demonstrated that enough people on both sides of the it-goes-too-far/it-doesn’t-go-far-enough divide can be found to deliver a majority.  That is especially true if members of the majority party conclude that acting on any consensus bill is better than going into the next election having passed nothing.

The CBO analysis will provide more detail on how the latest House amendments will impact on the coverage levels, costs and savings. The original CBO score of the AHCA indicated that 14 million more people would be uninsured next year and 24 million more would be uninsured by 2026 with cuts to Medicaid of $880 billion by 2026.

Last week Senator Majority Leader Mitch McConnell (KY) made public the fact that he has selected a group of 13 Republican Senators to craft a compromise bill either based on what the House has already adopted or starting from scratch.  In all likelihood, it will be a combination of the two approaches.

The 13 Senators, in addition to the Majority Leader includes the chairs of the two key committees, the Health, Education, Labor and Pensions (HELP) Committee Chair Lamar Alexander (R-TN), and Senate Finance Committee Chair Orrin Hatch (R-UT), the other 10 members include: Senator Rob Portman (R-OH), Senator Roy Blunt (R-MO), Senator Mike Lee (R-UT), Senator Tom Cotton (R-AR), Senator Cory Gardner (R-CO), Senator Pat Toomey (R-PA), Senator Mike Enzi (R-WY), Senator John Cornyn (R-TX),  (R-UT), Senator John Thune (R-SD) and Senator John Barasso (R-WY).

The naming of the committee raised some eyebrows in Washington DC because no women Senators were included.  Senator McConnell has rejected such criticisms saying this is a group that will hear from other members especially since they will need at least 50 votes for passage.

Discussions have been general this past week.  Ideas being discussed include discussions on whether or not tax credits should look more like current ACA law which now targets tax credits based on income levels.

The CBO score will also allow a review of which provisions of the House bill would violate the Byrd Rule which limits reconciliation bills. The Byrd rule prohibits provisions that are considered “extraneous” to reconciliation (the main mission of deficit reduction).  Some of the House bill’s language that strikes regulation of the insurance industry could fall short of what is a complicated rule that is ultimately decided by the Senate parliamentarian.