Senate Republicans are delaying the vote on their Affordable Care Act (ACA) replacement until after the July 4 congressional recess, missing a self-imposed deadline due to holdouts on both ends of the conservative spectrum. Moderate republicans like Susan Collins, R-Maine, disagreed with the cuts to Medicaid while far-right conservatives such as Rand Paul, R-Kentucky, and Ted Cruz, R-Texas, didn’t believe the bill went far enough in dismantling the ACA.
Majority Leader Mitch McConnell, R-Kentucky, told Senate Republicans he wants to make changes to the bill and get a new score from the Congressional Budget Office, according to CNN. While the Senate’s Better Care Reconciliation Act (BRCA) slightly improves on the House’s American Health Care Act (AHCA), the BRCA would still leave 22 million Americans without insurance by 2026.
"Sen. McConnell was wise to give it a few more days," Senator and health committee chair Lamar Alexander, R-Tennessee, told Politico. "Several members felt the bill wasn't ready to be voted on. We've been working on it for seven years and a few more days to get it right is a very sensible approach to me."
While reducing the number of insured Americans is a surefire way to reduce imaging utilization, the BRCA’s impact on radiology is compounded by the provision allowing states to apply for waivers freeing them from the ACA’s essential health benefits (EHB) requirement. One of the 10 EHB's call for insurers to cover copayments for certain preventative services, including mammography. This lead to increased rates of screening, especially in poor and minority groups, according to a study published in Cancer.
More recent research published in Cancer Epidemiology found the reduced copayments were responsible for earlier cancer detection and a reduction in racial/ethnic disparities in screening. A repeal of the ACA could reverse this trend, as the authors believed it was the availability of insurance that prompted people to seek out cancer screening.
Physician and nursing groups have come out almost unanimously against the bill, with the American Medical Association (AMA) saying it violates the first standard of medicine, the so-called “first, do no harm” principle.
"It seems highly likely that a combination of smaller subsidies resulting from lower benchmarks and the increased likelihood of waivers of important protections such as required benefits, actuarial value standards, and out of pocket spending limits will expose low- and middle-income patients to higher costs and greater difficulty in affording care,” said James Madara, CEO and executive vice president of the AMA.
Senate Republicans aim to have an updated bill on paper before the July 4 recess, allowing the Congressional Budget Office to score the revision over the holiday and the Senate to vote when they return.