President Donald Trump

Senators should stay in Washington until they pass a bill to repeal and replace the Affordable Care Act, President Trump said on Wednesday.

“We can repeal, but we should repeal and replace, and we shouldn’t leave town until this is complete,” Trump said, referring to an upcoming planned Senate recess. The remark was a change from the president’s recent pitches as recently as Tuesday for Congress to pass a repeal without a replacement or to “let ObamaCare fail” after efforts to repeal and replace had stalled.

His comment on Wednesday, made on camera at a White House lunch to which he invited Republican senators, came hours before the Congressional Budget Office released an analysis finding that a Senate bill to repeal the ACA without replacing it would lead to $842 billion in Medicaid cuts through 2026.

Vote uncertain

Later, in remarks on the Senate floor, Senate Majority Leader Mitch McConnell (R-KY) promised to push for debate on the repeal effort next week. The subsequent news that Sen. John McCain (R-AZ) was recuperating at home after surgery for brain cancer, however, cast uncertainty on when McCain could return to the nation’s capital for a vote.

Without a change of heart from some senators who already said they would not support a repeal of the ACA unless a replacement accompanied it, or from the senators who expressed concerns with the Senate’s repeal-and-replace bill, and with no support from Democrats in the Senate for either option, the Senate may not have enough votes to move forward.

Previous bills put forth this year by the House of Representatives and the Senate to repeal and replace the ACA have met with concerns from aging-services providers. Both the House’s American Health Care Act and the Senate’s Better Care Reconciliation Act proposed to change Medicaid funding from being open-ended to being capped through fixed payments to the states, threatening access to home- and community-based services that many assisted living operators provide through waivers. Neither bill passed out of its respective chamber in Congress.

Proponents of the bills said that funding the program in this way would give states more flexibility, and at his lunch, Trump said that Medicaid is “on an unsustainable path.”

“The states can do a better job than the federal government when it comes to healthcare,” he added. The federal government, he said, should concern itself with foreign policy matters.

CBO analysis

Wednesday evening, the CBO and Joint Committee on Taxation released an analysis that found that repealing much of the ACA without replacing it would result in an $842 billion net reduction in federal Medicaid spending through 2026. The CBO said that most of that reduction would come at the expense of adults aged fewer than 65 years who had become eligible for Medicaid under the ACA.

The office reviewed the repeal-only effort, called the Obamacare Repeal Reconciliation Act of 2017, as it was posted online that day by the Senate Committee on the Budget.

The CBO previously had found that two versions of the BCRA put forth by the Senate would have cut federal spending on Medicaid by $772 billion through 2026 compared with current projections under the ACA. An earlier analysis by the office also found that the House’s bill would have resulted in $834 billion of Medicaid cuts through 2026.

Read more about efforts to repeal and replace the Affordable Care Act under “Related Articles,” below.