After weeks of closed-door negotiations, Senate Republicans released a health-care bill today that would do away with large parts of the Affordable Care Act and cap funding for Medicaid, one of the nation’s biggest entitlement programs.
The 142-page Senate bill has been called a “discussion draft” and Senate leaders emphasized that the legislation is likely to change as amendments to the bill are introduced. The bill is being fast-tracked though, with Majority Leader Mitch McConnell (R-KY) eager to vote on the legislation next week, before the July Fourth recess.
That timeline, however, will depend on the reaction to the bill from rank-and-file senators. Even though Senate leadership is using reconciliation to evade filibusters from Democrats, McConnell still needs 50 of the Senate’s 52 Republican senators to vote in favor of the bill. Many senators, even Republicans, have been frustrated with the secretive process used to produce a bill, and have withheld public support until they have a chance to see what’s in it.
“I’m pleased that we were able to arrive at a draft that incorporates input from so many different members, who represent so many different constituents, who are facing so many different challenges,” McConnell said today. “There will be ample time to analyze, discuss and provide thoughts before legislation comes to the floor. I hope every senator takes that opportunity.”
The Senate bill is largely intended to be a compromise bill between the ACA and the health-care bill that House Republicans passed last month. Like the House bill, the Senate bill eliminates two central requirements of the ACA: that individuals provide proof of insurance and that companies with 50 or more employees provide health coverage for their workers. The Senate bill would continue for two years to fund subsidies that help millions of Americans buy insurance through the ACA marketplaces. The Senate bill also does away with all ACA taxes except the so-called “Cadillac” tax on high-cost health plans. Under the Senate plan, the Cadillac tax would be effective beginning in 2025 instead of 2020, as scheduled under current law.
In a bid to appease senators from states that expanded Medicaid under the ACA, the Senate bill would cut off expanded Medicaid funding more gradually than the House bill. The Senate bill would continue Medicaid expansion funding from the ACA through 2020, and then phase it out over the next three years. In 2025, the bill would begin to tie federal spending on Medicaid to an even slower growth index than the one used in the House bill, which could force some states to reduce the size of their Medicaid programs.
Moderate Republicans like Sen. Rob Portman (R-OH) and Shelley Moore Capito (R-WV) had pushed for a longer transition for states that expanded Medicaid under the ACA. Both Portman and Capito also wanted funding in the bill for states to treat and prevent opioid addiction, but as of today, that funding is not included in the draft. Neither Portman nor Capito has said whether they will support the Senate bill as written.
Other senators who have already said they oppose the Senate bill include Sens. Mike Lee (R-UT), Rand Paul (R-KY), Ron Johnson (R-WI) and Ted Cruz (R-TX).
“My main concern is I promised voters that I would vote to repeal Obamacare,” Paul said. “And everything I hear sounds like Obamacare-lite.”
The Senate bill will need to go through parliamentary scrutiny to make sure it meets the requirements of what can and can’t be included in the bill through the budget reconciliation process. The bill will also need to be scored by the Congressional Budget Office, which should happen within the next few days. CBO predicted the House bill would result in 23 million few Americans having insurance, so Senate leaders are hoping for a more favorable score on their bill.