The Senate is on the verge of unveiling a sweeping Obamacare repeal bill that would end Medicaid as an open-ended entitlement, roll back health insurance subsidies and strike multiple taxes from the Affordable Care Act.
The bill is expected to repeal the biggest parts of the Affordable Care Act, including the individual mandate and the employer mandate. It is also expected to defund Planned Parenthood for one year by kicking the women’s health organization out of the Medicaid program. That provision could be dropped if Majority Leader Mitch McConnell needs votes from moderate Republicans who oppose it.
Senate Republicans plan to release the draft at approximately 11 a.m. Thursday and hold a vote at the end of next week. Key parts could change as Republicans negotiate final details and try to come up with 50 votes they need to pass the bill. There are also unresolved questions about how much of the bill can be squeezed through the Senate’s strict budget rules governing the fast-track procedure called reconciliation that the GOP is using to avoid a filibuster.
John Cornyn (R-Texas) said a CBO score of the measure would be available by Monday, or possibly Friday. Budget Chairman Mike Enzi, who is responsible for getting the legislation through reconciliation, told POLITICO on Wednesday that he’s confident that Republicans’ priorities will make it through the reconciliation process. “We’re trying to both keep it a short enough bill so that people could read it but covering enough things so that states will have the ability to do whatever they need to do,” Enzi said.
Here’s what is known so far about the bill’s contents:
— It would eliminate Obamacare’s subsidy program and replace it with a different structure to help low-income people afford insurance. But Republicans are still trying to craft an alternative that would prohibit coverage of abortion without violating the strict reconciliation rules enabling them to pass the bill without a Democratic filibuster. Republican sources tell POLITICO they’re confident they can get the subsidy language through with the abortion prohibitions.
— Republicans plan to offer states a waiver to opt out of major parts of Obamacare and create their own health care rules. The bill would alter a waiver that was part of Obamacare — known as 1332 waivers — and make them easier to obtain.
States would be able to waive Obamacare’s insurance requirements, including one requiring states to have an exchange, as well as rules for what benefits insurers must cover, what qualifies as a health plan, and the actuarial value of the plans.
It is not expected to allow states to waive Obamacare requirements that insurers accept everyone and charge the same rates, with few exceptions. The House-approved American Health Care Act waived the latter requirement, triggering a storm of criticism that it was abandoning people with pre-existing conditions. Keeping the Obamacare requirements would mark a victory for GOP moderates but prompt pushback from conservatives, who want the waiver to be broader and allow more exclusions.
— The bill is expected to roll back Obamacare’s enhanced Medicaid spending — which is likely to force governors to cut coverage — over four years beginning in 2020. Earlier Senate conversations called for a three-year phase out. States would still be allowed to expand Medicaid through 2019.
— The bill is also expected to dramatically reshape Medicaid. Instead of an open-ended entitlement, states would get a set amount of money per person. In a win for conservatives, the Senate is expected to cut the program as aggressively as the House did until 2025 or 2026 and then make payments that grow in line with inflation. States are expected to have significant new flexibility for how they run their Medicaid programs. Republicans are likely to include a carve-out for certain children with complex medical needs, according to several sources.
Sen. Rob Portman (R-Ohio), who has been pushing the proposal, argued such a move would also make Medicaid function more efficiently. “They’ll get better care," he said. “It’s the right thing for these kids."
— The bill is expected to repeal Obamacare’s taxes, but how soon that is done is fluid because it would likely depend on how much tax revenue is needed to cover other costs associated with the GOP plan.
— Cost-sharing subsidies to help pay insurers for low-income individuals’ out-of-pocket expenses would be funded for two years. President Donald Trump has threatened to cut off those payments, which Republican lawmakers say were never properly appropriated.
— Lawmakers were weighing whether to dump the House health bill’s fund that would provide states with $115 billion to stabilize their insurance markets. Instead the fund would be rolled into a separate must-pass legislation to reauthorize the Children’s Health Insurance Program later this year. The move is being considered to preserve curbs on federal funding of abortion.
Many lawmakers remain skeptical the work can get done in such a tight time frame. "I don’t see how, again I’ll never say never, I just find it very hard to conceive that I’ll be able to gather all the information I need to justify a yes vote," said Sen. Ron Johnson (R-Wis.).
Rachana Pradhan, Burgess Everett, Adam Cancryn and Seung Min Kim contributed to this report.