Senate Health Care Bill Repeals Obamacare in Slower Increments Than House Version

Four key conservative Republican senators say they will not vote yes on the bill next week unless some provisions are changed.

By Rachel Alexander Published on June 23, 2017

Republicans in the Senate spent the past few weeks drafting a Senate version of the House health care bill that will replace Obamacare. Released Thursday, the “Better Care Reconciliation Act of 2017” is scheduled for a vote next Thursday, before the Fourth of July recess. It needs 50 votes for passage. There are 52 Republican senators, and Vice President Mike Pence could break a tie.

A 13-member working group worked behind the scenes under Senate Majority Leader Mitch McConnell’s direction. The 142-page bill is very similar to the House bill, the American Health Care Act, that passed in May. It gradually phases out most of Obamacare, but slower than the House version. The Congressional Budget Office is expected to release its analysis of the bill next week.

Not Enough Votes to Pass Yet

Sens. Rand Paul, R-Ky., Ted Cruz, R-Texas, Mike Lee, R-Utah, and Ron Johnson, R-Wis. came out yesterday against the bill in its current version. The conservative senators worry that the promised later phases of the repealing — like eliminating the subsidies — may not take place, if Republicans lose approval and maybe even control of the House and/or Senate.

Paul referred to the bill as “Obamacare lite.” He complained that the House bill already kept 90 percent of Obamacare’s subsidies. “If this gets any more subsidies in it, it may well be equal to what we have in Obamacare,” he stated. “So it really wouldn’t be repeal.”

Noticeably, McConnell no longer uses the phrase “repeal and replace” when discussing the bill. Instead, he says things like “We’re going to make every effort to pass a bill that dramatically changes the current health care law.”

Sen. Cruz said the key is lowering premiums and giving the states flexibility.

In a joint statement, the four senators said “we are open to negotiation and obtaining more information before it is brought to the floor.” Cruz expressed optimism. He said to “get everyone to yes” the key is lowering premiums and giving the states flexibility.

From the other side of the Republican party, Sen. Dean Heller, R-NV, rejected the bill. It is “imply not the answer. … It doesn’t protect Nevadans on Medicaid and the most vulnerable Nevadans.” Other senators will not say how they will vote.

Liberal Republicans Sen. Susan Collins, R-ME, and Sen. Lisa Murkowski, R-AK, may oppose it as well. “I don’t like the provision that eliminates federal funding for Planned Parenthood,” she says Collins. “There’s already a ban against using federal funds for abortions, so there’s absolutely no need for that.”

What the Bill Does and Doesn’t Do

The Senate version:

  1. Repeals the individual mandate (the requirement to have health insurance) and all or most of Obamacare’s taxes.
  2. Repeals the employer mandate for large employers retroactively to the beginning of 2016.
  3. Phases out the Medicaid expansion by 2024 and changes how the Medicaid program is funded. Obamacare subsidies to health insurance providers would be phased out by 2020. States could start work requirements for Medicaid recipients.
  4. Prohibits states from opting out of covering patients with preexisting conditions.
  5. Drops the income cap for families eligible for tax credit subsidies from 400 percent of the poverty level to 350 percent. The House version bases subsidies on age instead of income.
  6. Provides $50 billion over the next four years to states to shore up insurance markets.
  7. Health plans that offer abortion services are not eligible for the subsidies. This blocks funding to Planned Parenthood.

The Republican Study Committee, a conservative caucus of House Republicans, sent a letter to Senate Republicans on Wednesday about the bill. The bill must include four “crucial” items in their agenda, they say. They are:

  1. Stop expanding Medicaid immediately and phase it out by 2020.
  2. Allow states to waive certain Obamacare requirements.
  3. Repeal the new taxes created by Obamacare quickly.
  4. Prevent federal funding and refundable tax credits for abortion providers.

The Senate’s version  achieves the first, third and fourth, but not as strongly as quickly as the House version will. It phases out the Medicaid expansion more slowly, and leaves larger tax credits in place, for example.

While the Senate bill doesn’t instantly replace Obamacare, or phase it out as quickly as the House bill, it certainly lays out a path to gradually do that.

States aren’t permitted to opt out of the Obamacare requirement of covering patients with preexisting conditions. Trump said this would be part of the bill. Letting the states opt out was a reason the bill passed the House. The House Freedom Caucus made it a key issue in order to obtain their support. Trump has privately criticized the House version as “mean.”

The Bill’s Future

Democrats complained that the bill was drafted behind closed doors. Unlike House Republicans, Senate Republicans didn’t hold any public hearings on the bill.  However, Democrats negotiated the final aspects of Obamacare in secret seven years ago.

The bill is unlikely to attract any Democratic support. Democrats claim it will leave fewer people insured. Sen. Bernie Sanders, I-Vt., called it “by far the most harmful piece of legislation I have seen in my lifetime.”

While the Senate bill doesn’t phase out Obamacare as quickly as the House bill, it lays out a path to do that. There will be a tough battle next week between the conservative and moderate Republican senators who require changes to the bill, and the president and the rest of the Republican senators.

If the bill passes the Senate, it will go to reconciliation with the House version. It could face just as stiff opposition there. Ultimately, it will pass if the conservative members of Congress and their constituents think the bill goes far enough to repeal Obamacare.

 

Follow Rachel on Twitter at Rach_IC.

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