On Thursday, Senate Republican leaders, who have promised to repeal former President Barack Obama’s healthcare legislation for seven years, moved forward on that goal with the release of a draft of their plan to repeal and replace the Affordable Care Act. Senate Republicans said they expect to vote on the bill, calld the Better Care Reconciliation Act, next week.
The bill is similar to the one passed by the House Republicans in May, called the American Health Care Act, as far as its overarching goals, including eliminating many of the ACA’s insurance regulations, coverage mandates and taxes, but according to many media reports, the Senate bill calls for deeper cuts and structural changes to Medicaid. It is expected that the Congressional Budget Office (CBO) will release an analysis of the Senate healthcare bill early next week.
As The New York Times’ article, posted Thursday afternoon, noted, “The 142-page bill would create a new system of federal tax credits to help people buy health insurance, while offering states the ability to drop many of the benefits required by the Affordable Care Act, like maternity care, emergency services and mental health treatment.”
What’s more, the NYT article states, “The Senate bill — once promised as a top-to-bottom revamp of the health bill passed by the House last month — instead maintains its structure, with modest adjustments. The Senate version is, in some respects, more moderate than the House bill, offering more financial assistance to some lower-income people to help them defray the rapidly rising cost of private health insurance.”
The NYT article continues, “But the Senate measure, like the House bill, would phase out the extra money that the federal government has provided to states as an incentive to expand eligibility for Medicaid. And like the House measure, it would put the entire Medicaid program on a budget, ending the open-ended entitlement that now exists.”
Further, the article from the New York Times points out that the Senate health care bill would repeal virtually all the tax increases imposed by the ACA to pay for itself, “in effect handing a broad tax cut to the affluent, paid for by billions of dollars sliced from Medicaid, a health care program that serves one in five Americans, not only the poor but almost two-thirds of those in nursing homes.”
The bill also would end federal funding for Planned Parenthood for one year.
While the House health care bill provided $45 billion over 10 years to combat the opioid epidemic, the Senate bill proposed providing $2 billion to states in 2018 to address the national opioid crisis.
According to a Senate Republican health care discussion draft document, Senate Republicans supporting the bill contend that the legislation will help stabilize insurance markets, eliminates the ACA’s individual and employer mandates, will improve the affordability of health insurance, will preserve access to care for Americans with pre-existing conditions, and allow children to stay on their parents’ health insurance through age 26 and will strengthen Medicaid for those who need it most “by giving states more flexibility.”
Republicans have been seeking to repeal the ACA for seven years, arguing that the ACA insurance exchanges are collapsing. In a press release, U.S. Senate Majority Leader Mitch McConnell (R-KY) stated, “Seven years ago, Democrats imposed Obamacare on our country. They said it would lower costs. It didn’t. From 2013 to 2017, premiums have on average doubled in the vast majority of states on the federal exchange. Next year, Obamacare premiums will go up across the country again — potentially by as much as 43 percent in Iowa, and 59 percent in Maryland, even a staggering 80 percent in New Mexico. Does it sound like Obamacare is working? They said it would increase choice. It didn’t. This year, 70 percent of American counties have had little or no choice of insurers under Obamacare. Next year, at least 44 counties are projected to have no choice at all — meaning, yet again, Americans could be thrown off their plans in states like Missouri, and Ohio, and Wisconsin. Does it sound like Obamacare is working?”
According to reporting from another New York Times article detailing how the Senate bill would alter Obamacare, with regard to Medicaid expansion, the proposed bill “allows the 31 states that expanded Medicaid to continue getting federal funding through 2023, with reduced funding starting in 2021. Medicaid expansion would end in 2024.”
Separate from the expansion, the bill caps future federal funding per enrollee, based on how much each state has spent historically. States also have the option to receive a lump-sum block grant for some beneficiaries, according to the NYT article.
As far as subsidies for out-of-pocket costs, in which the ACA provided subsidies to help people with lower incomes pay for out-of-pocket costs like deductibles and co-payments, the Senate bill preserves the subsidies through 2019, then eliminates them altogether.
The Senate bill preserves the rule in the ACA that requires all insurers to offer 10 categories of essential health benefits, like maternity treatment and hospital care, however, states could apply to waive the standards. “This means that some types of care, like maternity benefits, prescription drugs or addiction treatment, might not be covered in states that waive the rule,” according to the NYT reporting.
The Senate bill also keeps the ACA’s requirement that insurers must cover people regardless of pre-existing medical conditions and bars them from charging people more based on an existing medical condition. However, according to reporting from Politico, states could waive other insurance rules that could weaken protections for medical conditions, such as the basic benefit package and the minimum payments insurers must make toward medical bills.
