The Health 202: Here's what's in the Senate health-care billThe Washington Post, Jun 22, 2017
Senate GOP leaders are poised to release an Obamacare overhaul that clearly tries to woo the moderate members of their party while also keeping spending in check and giving conservatives a few goodies, too.
Yesterday afternoon, The Health 202 scooped the major details of the draft health-care legislation that Senate Majority Leader Mitch McConnell (R-Ky.) wants to bring up for a vote next week. Like the House bill passed in May, the Senate version would put big dents in the Affordable Care Act, repealing just about all of its taxes, pulling back on Medicaid expansion and ditching the individual mandate to buy coverage and the employer mandate to offer it.
But the Senate bill contains three elements McConnell is betting will win over a half dozen or so moderates who remain skeptical but whose votes are crucial to overall passage (remember: the majority leader needs only 50 votes since arcane budget rules are being applied to the measure, meaning he can lose just two Republicans). McConnell's draft, hashed out behind closed doors, basically retains Obamacare's insurance subsidy structure -- with just a few tweaks -- takes a gentler approach than the House bill in the short-term to Medicaid expansion, and wouldn't allow states to opt out of key protections for patients with preexisting conditions.
The idea, aides and lobbyists say, is to provide a softer landing for people at lower ends of the income spectrum than under the House bill. That measure based the subsidies only on age and didn't peg them to actual premiums, resulting in estimates of dramatic cost spikes for some Americans and prompting a heavy onslaught of public criticism that spooked many House moderates.
The Senate bill tries to fix that problem -- sort of. Its subsidies closely mirror Obamacare subsidies, which are currently available to Americans earning between 100 percent and 400 percent of the federal poverty level. Starting in 2020, under the Senate bill, this assistance would be capped for those earning up to 350 percent — but anyone below that line could get the subsidies if they’re not eligible for Medicaid. As under the ACA, the subsidies would be pegged to a benchmark insurance plan each year, ensuring that the assistance grows enough over time to keep coverage affordable for customers.
The Senate bill also retains the ACA's protections for patients with preexisting conditions. It eliminates the House bill's pathway for states to lift a ban on insurers from charging people with serious medical conditions higher premiums, which would have been another political hotbed for moderates. It does expand the use of certain "1332 waivers" to give states more flexibility -- a provision that conservatives like Sen. Ted Cruz (R-Tex.) wanted -- but those waivers don't open the door to ducking the preexisting protections.
The Senate bill would also provide funding in 2018 and 2019 for extra Obamacare subsidies to insurers to cover the cost-sharing discounts they’re required to give the lowest-income patients. Insurers have been deeply concerned over whether the subsidies will continue, as the Trump administration has refused to say whether it will keep funding them in the long run.
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