Republican Senators previously appointed by Senate GOP leadership reportedly are continuing to draft Senate health care legislation to repeal and replace the Affordable Care Act (ACA) without any scheduled committee hearings on the bill. While the text of the Senate health care bill remains undisclosed, Republican Senators have reportedly been working to reach a consensus on when to end Medicaid expansion, the size of tax credits for assisting low income and older Americans with the cost of health insurance, and continued coverage for people with pre-existing conditions without increased insurance premiums.

Like the American Health Care Act of 2017 (AHCA), which the U.S. House of Representatives passed in early May, the Senate Republican health care legislation apparently will call for the end of Medicaid expansion. What remains unclear is how quickly Medicaid expansion would end under the Senate health care bill. Three options for ending Medicaid expansion reportedly have been proposed by Republicans: ending Medicaid expansion in 2020 as included in the AHCA; a seven-year gradual reduction in Medicaid expansion payments from 2020 to 2027; and a three-year phase out option.

On June 13th, the Centers for Medicare and Medicaid Services published a map of projected ACA health insurance exchange participation by county for 2018. The map is based on public announcements by insurers to participate in the ACA exchanges. While many insurers have been exiting the individual ACA insurance exchanges, insurer Centene announced plans to start offering coverage in ACA marketplaces in Missouri, Kansas, and Nevada and to expand its existing insurance offerings in Florida, Ohio, Texas, and Washington.

The Medicare Payment Advisory Commission (MedPAC) released its June 2017 Report to the Congress: Medicare and the Health Care Delivery System. As mandated by Congress, the report includes MedPAC’s suggestions for refining the Medicare payment system and addressing issues related to the Medicare program. In the June 2017 report MedPAC suggests implementing a unified payment system for post-acute care, improving payment for Medicare Part B drugs, and redesigning the Merit-based Incentive Payment System.