WASHINGTON — Senate Republicans have unveiled a draft of their legislation to revamp the government’s role in the nation’s health care system, a proposal that includes big reductions to Medicaid, defunds Planned Parenthood, eliminates the Obamacare mandate requiring individuals to purchase insurance and offers tax credits to help people afford insurance while slashing taxes for the wealthy.
The major change to health care comes in the form of Medicaid. The bill winds down the expanded Medicaid program under Obamacare after 2020 — a longer timeline than the House health care bill that was passed in May. But it also makes deeper cuts to the program in the long run, by 2025, through changing the federal funding allocation formula for states to receive fewer federal dollars for Medicaid recipients. The bill also allows states to implement work requirements for Medicaid recipients. It’s an attempt at a compromise to appease those Medicaid advocates like Sens. Rob Portman of Ohio and Susan Collins of Maine as well as conservatives like Sens. Mike Lee of Utah and Ted Cruz of Texas.
Related: Read the Senate Health Bill
Some major components of Obamacare are kept in place, however. Republican senators say the bill makes no changes in the law protecting Individuals with pre-existing conditions from being denied insurance. And young adults up to the age of 26 are able to keep stay on their parents’ insurance.
The measure also keeps a similar program to help people who purchase insurance out of pocket, known as the individual marketplace, afford the insurance through tax credits based on income, combining the ideas behind Obamacare and the House bill. The House bill gave people tax credits based on age, severely impacting older Americans who would see premiums rise by more than 700 percent, according to analysis of the bill.
By basing tax credits on income, the Senate is aiming to ensure older Americans are not penalized. But unlike Obamacare, which gives a subsidy upfront, the Senate bill would provide a tax credit, to be received after the fact.
Planned Parenthood is de-funded in this bill and it restricts tax credits from being used for insurance plans that provide abortion.
And taxes on the wealthy are repealed. A .9 percent tax on income for those making more than $250,000 per year is repealed in 2022 but a three percent tax on investment income is repealed retroactively, going back to 2016.
In an effort to prop up the Obamacare marketplace where insurance companies are exiting the market in some regions, leaving few or no options for people, this bill would provide an additional $15 billion per year until 2020 and $10 billion per year in 2020 and 2021 to insurance companies for them to stay in the marketplace to provide insurance in the individual market.
In the same vein, the Senate bill continues cost-sharing reduction payments through 2019. Those payments help lower income Americans purchasing insurance in the individual market pay for deductibles and co-payments.
The details of the bill had been tightly held by Republican leaders as Senate Majority Leader Mitch McConnell wrote a bill that aims to appeal to his most conservative members and the most moderate in his 52-member conference. With no Democrats expected to support a repeal of the Affordable Care Act, McConnell can only afford to lose two votes for the measure to pass.
Republican senators filed into a room in the U.S. Capitol Thursday morning, sat in chairs lined up in rows to listen to a presentation of a “discussion draft” of the legislation that could be voted on as early as next week.
They emerged from their meeting with mixed reactions. Some conservatives were not please.
“This is not Obamacare repeal,” Sen. Ron Johnson, R-Wisc., said. Johnson has been advocating a bill that more drastically cuts from the Affordable Care Act.
Sen. John Thune, R-S.D., and a member of Republican leadership, said that changes are still likely.
“We’ve got members who are going to be interested in looking at the text and looking to see what they can do to refine and improve and dial things accordingly to try and figure out how we get 50 votes,” Thune said. “There’s a lot of areas that are probably subject to dials: tax credit, Medicaid.”
Drafts of the bill circulated among Washington lobbyists in the days leading up to its reveal even as Republican Senators remained unaware of its contents.
According to Senate rules, the Senate can vote on this bill only after it is scored by the non-partisan Congressional Budget Office. Senators expect that analysis to be done as early as Friday or perhaps Monday.
The CBO analysis of the House bill says that 23 million people would lose insurance in the next decade under their bill, which President Donald Trump called “mean” in a meeting with senators earlier this month.
Protests erupted around the Capitol complex against the bill. And Democrats immediately slammed the measure.
“The way this bill cuts health care is heartless,” said Senate Democratic Leader Chuck Schumer on the Senate floor. “The president said the house bill is mean. The senate bill may be meaner.”
Protesters with disabilities, including many in wheelchairs, jammed the hall outside of McConnell’s office until removed by police. At least 15 people were arrested in the die-in.
If the Senate passes a bill, it would then go to the House for a vote unless the two legislative bodies decide to get together and hammer out a compromise bill. But Sen. Lindsey Graham, R-S.C., predicted that this bill would be difficult to pass the House.
“I think we’re probably going to get a lot of push back from people from the right in the House, but I want to look at it in terms of South Carolina,” Graham said.