Senate Republican leadership released its long-awaited healthcare bill Thursday, ending weeks of speculation and a secretive process that frustrated Democrats and even some Republicans.
The legislation — called the Better Care Reconciliation Act of 2017 — would roll back much of the Affordable Care Act, the healthcare law better known as Obamacare, including various tax provisions, and scale back funding that goes toward health coverage for low-income Americans and tax credits for middle-income earners who purchase their own health insurance.
The plan would also provide funding designed to help stabilize the Obamacare insurance markets in the near term and funnel money through programs to cut off access to funding for abortion providers.
The Senate legislation contains key differences from the American Health Care Act, the House GOP’s legislation to dismantle Obamacare. The disparities could be sticking points if the two chambers have to compromise on the bill, which they would have to do before it could reach President Donald Trump’s desk.
But first, the legislation faces an uncertain future in the Senate, as it faces some pushback from both conservative members who think it may not go far enough in repealing Obamacare and moderates concerned about its slashing of Medicaid spending. Like the House legislation, it could be subject to significant change to get the needed number of votes.
Senate Majority Leader Mitch McConnell is pushing for a vote by the end of next week, in part to avoid further public scrutiny of the bill over the week long July 4 recess. Similar scrutiny periled the original version of the House legislation. McConnell can afford to lose just two members of his conference for the bill to pass.
Many of the key details are similar to leaked details from Wednesday. Here’s a rundown of what is in the bill:
- Tax credits:
- What’s in the bill: To help people pay for insurance, the Senate bill proposes tax credits based on income level, a feature of Obamacare, rather than on age, as the House bill calls for. The bill would make anyone earning up to 350% of the poverty level eligible for credits; Obamacare caps that at 400%. Additionally, the credits would cover only 58% of the actuarial value of the plans.
- What it means: While the tax credits would be more generous for older Americans than the House bill, fewer middle-income people would get financial support to pay for coverage — and those who do would get less.
- Medicaid expansion:
- What’s in the bill: Obamacare’s Medicaid expansion, which extended the program to those making 100% to 138% of the federal poverty limit, would be phased out over three years starting in 2020.
- What it means: While this would save the federal government money, it also means the nearly 11 million people who have gained coverage through the expansion could be phased off the program.
- Medicaid spending growth:
- What’s in the bill: The Senate bill retains the House’s per capita cap for federal Medicaid spending. After 2025, however, growth in spending would shift from the consumer price index for medical care to the CPI for all goods, a lower level of growth.
- What it means: States would receive less funding each year from the federal government to help cover low-income Americans, and after 2025 the rate of growth would decline, leading to even deeper potential cuts for the program.
- Cost-sharing subsidies:
- What’s in the bill: The bill would allocate money for cost-sharing subsidies through 2019. These payments offset the costs for insurers to offer low-income Americans plans with smaller out-of-pocket costs. The uncertainty around these payments has led to instability in the individual insurance market.
- What it means: This should reassure insurers desperate for guidance ahead of the 2018 plan year and could bring down premium increases for next year’s individual insurance market.
- State waivers for Obamacare regulations:
- What’s in the bill: The Senate bill would allow states to request a waiver to opt out of Obamacare’s so-called essential health benefits, which mandate that all plans must cover 10 basic types of care. The ability to opt out of providing those benefits was a key sticking point in the House legislation, and its inclusion ultimately allowed it to pass. The Senate bill, however, would not allow states to repeal community rating, the provision mandating that all people of the same age in the same area be charged the same amount. That’s a change from the House bill, which drew criticism from health-policy experts who said a repeal of community rating would allow insurers to charge people with preexisting conditions more.
- What it means: If a state receives a waiver for the EHBs, this would allow skimpier coverage offerings on the state’s insurance market, which would have cheaper premiums but higher out-of-pocket costs.
- Repeal Obamacare’s taxes:
- What’s in the bill: Much like the House version, the Senate would do away with things like Obamacare 3.8% tax on investment income on people earning an annual income above $200,000.
- What it means: The taxes in Obamacare fall predominantly on a small percentage of wealthy Americans, who would see their tax bills fall. For instance, Republican megadonor and casino magnate Sheldon Adelson could have his 2017 tax bill cut by roughly $44 million.
- Shift around key funding to prevent it from going to healthcare providers involved in abortion procedures:
- What’s in the bill: The House bill’s $115 billion state-stability fund intended to help stabilize the individual markets contains language designed to prevent it from being used to fund a healthcare organization that provides abortions. That doesn’t fly under the Senate’s stricter rules for how a bill like this one can be passed. The Senate version would funnel this money through the Children’s Health Insurance Program, which is already subject to the abortion rule, essentially a roundabout way to restrict money from going to abortion providers.
- What it means: This allows the bill to qualify under arcane Senate rules and essentially freezes providers like Planned Parenthood from receiving any of the billions in new funds in the bill.
See the full bill below: