Millions Will Lose Health Coverage

Senate Republican leaders released a draft of their long-awaited ObamaCare repeal-and-replace bill ahead of a high-stakes vote expected next week. The controversial plan will make massive cuts in Medicaid to pay for tax cuts.

The plan, whose development was overseen by Senate Majority Leader Mitch McConnell (R., Ky.), attempts to strike a balance between the demands of conservative GOP senators who want an aggressive repeal of the ACA, sometimes called Obamacare, and more centrist lawmakers eager to retain some aspects of the law. The measure will reshape Medicaid from an open-ended government commitment to a system of capped federal payments each year.

The bill repeals billions of dollars in taxes that were used to raise money for ObamaCare’s coverage expansion and also abolishes the law’s mandates to buy coverage. The bill relies on the 2010 law’s current tax credits to provide subsidies to people who don’t get health insurance on the job. But this legislation would tighten the income eligibility for the assistance, meaning fewer people would be able to get the subsidies. The credits would also be less robust than under the ACA.

The Senate health care bill would result in 22 million more uninsured Americans over the next decade compared to current law. That’s according to an analysis from the nonpartisan Congressional Budget Office.

“It’s time to act because ObamaCare is a direct attack on the middle class and American families deserve better,” Senate Majority Leader Mitch McConnell (R-Ky.) said Thursday. “They deserve better care.”

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Senate Democratic Leader Charles Schumer (N.Y.) countered by pointing to the bill’s tax cuts, which will cut services to the poor, aged and disabled. Meanwhile, the tax cuts will benefit high earners.

“This is a bill designed to strip away healthcare benefits and protections from Americans who need it most in order to give a tax break to the folks who need it least,” Schumer said.

The Republican measure phases out the federal funding for ObamaCare’s expansion of Medicaid, which has provided coverage for about 11 million people in 31 states. The funding will phase out over four years from 2020 to 2024, which is less than the seven-year phase-out pushed by more moderate Republicans.

The measure includes deeper cuts to Medicaid than the House bill, starting in 2025. Starting in that year, the cap on Medicaid payments would start growing at a slower rate, leading to deeper cuts over time. The Senate proposal would cap states’ Medicaid funding for the first time in the program’s history. 

It remains to be seen how centrist Republicans, like Sens. Rob Portman (R-Ohio) and Shelley Moore Capito (R-W.Va.), will react to the shorter timeframe for the Medicaid phase-out. Some, like Sen. Lisa Murkowski (R-Alaska), have indicated they might not want to phase out Medicaid expansion funding at all. But those senators will be under intense pressure from leaders to back the bill and deliver a legislative victory to President Trump.

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The legislation keeps much of ObamaCare’s tax credit structure in place, a shift from the House bill, which created a new, less-generous tax credit system. Still, the Senate bill scales back the ObamaCare tax credits to provide less assistance to people when buying coverage.

The measure would strip federal funding from Planned Parenthood Federation of America for one year, and it prohibits tax credits from being used to purchase plans that offer abortion coverage.

Democrats and many rank and file Republican lawmakers criticized GOP leaders for keeping the details of the bill secret until Thursday. The release gives lawmakers and the public about one week to review the bill before the vote, which some Republican lawmakers have said might not be enough time.

Mr. McConnell has set a rapid-fire timeline for passage. An analysis by the nonpartisan Congressional Budget Office, laying out the bill’s effect on the budget and the number of uninsured, could come as early as Monday. Republican Senators, some of whom hadn’t seen text of the draft bill until its release, would have a week to digest it before a possible vote in advance of their July 4 recess. House Republicans would then take up the bill under a similar fast track.

The CBO report on the House-passed bill, released late last month, showed it would leave 23 million more people uninsured while reducing the cumulative federal deficit by $119 billion in the next decade compared with current law. It will be interesting to see the CBO’s evaluation of the current proposal.

Call or e-mail your senators to let them know what you think about the proposed legislation. Go here. In the upper left hand corner is a link to “Find Your Senators.” Select your state from the drop down menu and the next screen will show your two senators’ names along with their phone numbers and links to their emails.

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