The Senate's new Better Care Reconciliation Act bill mightfail, but it could still pass.

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Republicans hold just 52 seats in the Senate. Senate MajorityLeader Mitch McConnell is struggling to get more conservative andmore moderate Republicans to unite behind the version of theAffordable Care Act change bill released Thursday. At press time,at least eight Republican senators were publicly expressingskepticism about the idea of voting for the bill.

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In the past, however, backers of other health bills have facedsimilar problems with rounding up votes and triumphed.

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In 2009 and 2010, when the Democrats were working on the billsthat created the Affordable Care Act, they had trouble with gettingthe most liberal Democrats and the most moderate Democrats to votefor the same bill.

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Related: Poll: What do you think about the GOP Senate draftof the AHCA?

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In May, when House Speaker Paul Ryan brought the House ACAchange bill, the American Health Care Act bill, to the House floor,no one knew what would happen. House members ended up passing it bya 217-213 vote.

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Sen. John Cornyn, R-Texas, told Bloomberg today that he's confidentthe Better Care Reconciliation Act bill will attract enoughRepublican votes to get through the Senate.

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The 142-page Better Care draft is written in a dense, confusingway, with many key provisions that would change the laws now inforce by adding sentence fragments, deleting several words, oradding or deleting punctuation marks. The draft does not alwaysexplain what effect those changes are supposed to have.

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Perhaps as a result, commentary on specific provisions in thedraft has been scarce.

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Here's a look at five of the more focused reactions that cameout since the bill's release.

1. Insurers have mixed feelings.

America's Health Insurance Plans, a group for health insurers,is not taking an official position on the draft. It told Bloombergthat it likes the commercial insurance subsidies in the draftbut has concerns about provisions that would phase in dramatic cutsin Medicaid funding.

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Related: Anthem pulls out of two morestates

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The Blue Cross and Blue Shield Association is also praising thesubsidy provisions, but it says the Senate needs to add strongincentives for people to keep themselves covered.

2. Experts think a state Affordable CareAct waiver program expansion program provision could bepowerful.

The Patient Protection and Affordable Care, part of the ACA,already includes a Section 1332 waiver program provision.A state can use that provision to tinker with how its exchangeprogram works, and with other ACA rules.

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The Senate Better Care draft would let a state use Section 1332to change many different ACA rules. The draft makes understandingwhich rules the draft could actually change difficult. The draftstates that a state could ask to change the rules described in oneparagraph in PPACA Section 1332. That paragraph in PPACA Section1332 refers, in turn, to six major sections of PPACA. Some ofthose six sections may, in turn, refer to additional sections.

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Joseph Antos and James C. Capretta of the American EnterpriseInstitute write in a blog on the website of Health Affairs, anacademic journal, that they think a state could use a Better CareSection 1332 waiver to change its essential health benefitspackage, or standard benefits package, but not to bring backmedical underwriting.

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Tracy Watts, a health policy specialist at Mercer, says ina commentary that she also thinks the waiverprovision would let a state change its essential health benefitspackage. "We will take a deeper look into this issue and post aboutit next week," Watts writes.

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Any changes in the essential health benefits program couldaffect large group plans, including self-insured plans, as well asindividual and small-group plans, because group plans must provideunlimited benefits for any essential health benefits that they docover.

3. The Section 1332 waive program expansion could letstates give insurers the ability to issue limited-benefitcoverage.

Timothy Jost and Sara Rosenbaum write in another HealthAffairs blog that the Better Care waiver programprovision has a potential problem: It would let the U.S. Health andHuman Services secretary approve or reject a waiver proposal basedonly on what the proposal would do to the cost or use of healthcoverage.

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The provision "ignores both how comprehensive the coverage mustbe and how high cost-sharing may be under the waiver," Jost andRosenbaum write.

4. Fitch Ratings thinks the Better Care draft rulescould be hard on insurers with large individual health or Medicaidoperations.

The draft would provide more cash for individual commercialhealth insurance subsidies, but it would keep the current ban onmedical underwriting, according to Fitch.

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The subsidy money would help insurers, but keeping the ban onmedical underwriting would limit insurers' ability to manage risk,Fitch says.

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Changes and reductions in federal Medicaid funding could hurtinsurers, but that funding pressure could also help insurers, bypushing states to make more use of Medicaid programs managed byoutside companies, Fitch says.

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"Additionally, with such sweeping legislation, unintended andunforeseen consequences are likely to create uncertainty over theultimate net effect on health insurers," Fitch says.

5. The Better Care draft could wipe out bare-bonesgroup health benefits.

Before the Affordable Care Act came along, some employersoffered at least some workers limited-benefit health plans, orplans designed to provide anywhere from about $1,000 to $200,000 inhealth benefits.

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Related: Industry insiders ponder AHCA impact on groupmarket

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The Affordable Care Act has eliminated traditionallimited-benefit medical plans in the individual and small-groupmarkets, but large groups can now offer bare-bones major medicalplans that provide just enough coverage to meet the ACA employer"minimum essential coverage" offer requirements.

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Compliance lawyers say in a commentary that the Better Care draftcould wipe out the market for bare-bones minimum essential coverageproducts.

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Elimination of the ACA employer mandate would end the pressurefor employers to offer the products to avoid ACA penalties, theLockton lawyers write.

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Meanwhile, the Lockton lawyers write, making those minimum-valueproducts available to workers could shut those workers out of anyhealth insurance premium subsidy system that still exists, because,after 2019, the Better Care draft premium tax credit subsidyprogram would shut out any worker who had access to anyemployer-sponsored minimum essential coverage.

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Allison Bell

Allison Bell, ThinkAdvisor's insurance editor, previously was LifeHealthPro's health insurance editor. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached at [email protected] or on Twitter at @Think_Allison.