While there has been considerable activity in the Senate over the past week, plans for bringing a health system reform bill to the floor for a vote remain very fluid. Under pressure from both President Trump and a long legislative to-do list, Senate Majority Leader Mitch McConnell has said he would attempt to bring repeal legislation to the floor again tomorrow.

At this point, it appears that two substitute amendments for the House-passed American Heath Care Act (AHCA) are likely candidates to serve as the basis for Senate debate:

• A revised version of the Obamacare Repeal and Reconciliation Act (ORRA), vetoed by President Obama in 2015, that eliminates the individual and employer mandate penalties, as well as all insurance premium subsidies and Medicaid expansion funds; or

• The Better Care Reconciliation Act (BCRA), which was updated last week to include additional funding for opioid addiction treatment and for market stabilization, among other changes.

It is unclear whether the Senate will be able to garner the 50 votes to move any health care legislation at all. To date, enough Senators have expressed opposition to either substitute to block its consideration, though negotiations are ongoing. California Senators Dianne Feinstein and Kamala Harris are opposed to both bills.

Moreover, the Senate Parliamentarian issued a blow to Senate Republicans on Friday by opining that the following provisions cannot be included in a reconciliation bill: Defunding of Planned Parenthood, abortion restrictions on tax credits, repeal of the essential health benefits and the health plan medical loss ratio, and finally, the continuous coverage provision (which is the Republican alternative to the individual mandate).

Given the California Medical Association’s (CMA) objectives for health system reform, CMA has serious concerns with both Senate proposals. CMA does not support repeal legislation without a replacement. CMA's position remains rooted in its policy, which supports expanding access to affordable and meaningful health insurance coverage and preserving the Medicaid safety net.

CMA objects to the current proposal because it would cause nearly 4 million Californians to become uninsured, impose $114 billion in cuts to California’s Medi-Cal program over the next decade, and not help low- to moderate-income families afford insurance.

CMA has called upon Congress to engage in bipartisan discussions with physicians and other health care organizations to improve our health care system and ensure access to high-quality, affordable care and coverage.

In a bipartisan move, a group of moderate Democrats, led by California Congressman and Sacramento physician Ami Bera, M.D., released a plan last week to improve the Affordable Care Act. They are calling on Congress to come together across party lines to provide stability in the health care system.