Early this morning, the so-called skinny or partial ACA repeal package was defeated by a vote of 49 to 51 with Senators Collins, Murkowski and McCain joining all 48 Democrats in opposing the proposal. Elements included in the “skinny” package were: · Repeal of the individual mandate by zeroing out the penalty beginning after December 31, 2015. · Repeal of the employer mandate by zeroing out the penalties, but only from January 1, 2016 to December 31, 2024. · Extend the moratorium on the medical device tax from December 31, 2017 to December 31, 2020. · Increase for three years (2018 to 2020) the maximum contribution limit to health care savings accounts (HSA) to the amount of the deductible and out-of-pocket limitations. · Defund Planned Parenthood for one year (and expands the one-year defunding to certain other providers that provide abortions if they receive more than $1 million in federal and state funding). · Sunset the funding for the Prevention and Public Health Fund after FY 2018. · Provide $422 million in additional funding for the Community Health Center Program in 2017. · Amend section 1332 of the ACA (Waiver for State Innovation) by: authorizing and appropriating $2 billion for states that submit or implement state innovation waivers; requiring HHS to approve a 1332 waiver if the secretary determine that the application meets the benefit comprehensiveness, cost sharing, enrollment, and budget neutrality guardrail requirements; requiring a waiver determination within 45 days (instead of 180 days); and extending waivers from 5 to 8 years with unlimited renewals for 8-year periods that may not be cancelled by the secretary. Following the “skinny” bill vote, Sen. McConnell pulled the reconciliation bill from consideration. This is not the end of the process. Hearings and bipartisan discussions about legislation to stabilize the individual market are anticipated when Congress returns from the August recess.