After weeks of secret negotiations, evil GOP bastard Mitch McConnell is ready to release the GOP plan to repeal and replace Obamacare to rank and file GOP senators today, and is expected to release the bill publicly ahead of the vote next week. Senate GOP leaders set to unveil health-care bill.
The Washington Post purportedly has a leaked copy of the “discussion draft” for rank and file GOP senators this morning. Senate health-care draft repeals Obamacare taxes, provides bigger subsidies for low-income Americans than House bill:
A discussion draft circulating Wednesday afternoon among aides and lobbyists would roll back the Affordable Care Act’s taxes, phase down its Medicaid expansion, rejigger its subsidies, give states wider latitude in opting out of its regulations and eliminate federal funding for Planned Parenthood.
The bill largely mirrors the House measure that narrowly passed last month but with some significant changes aimed at pleasing moderates. While the House legislation tied federal insurance subsidies to age, the Senate bill would link them to income, as the ACA does. The Senate proposal cuts off Medicaid expansion more gradually than the House bill, but would enact deeper long-term cuts to the health-care program for low-income Americans. It also removes language restricting federally subsidized health plans from covering abortions, which may have run afoul of complex budget rules.
Senate Majority Leader Mitch McConnell (R-Ky.) intends to present the draft to wary GOP senators at a meeting Thursday morning. McConnell has vowed to hold a vote before senators go home for the July 4 recess, but he is still seeking the 50 votes necessary to pass the major legislation under arcane budget rules. A handful of senators, from conservatives to moderates, are by no means persuaded that they can vote for the emerging measure.
Aides stress that the GOP plan is likely to undergo more changes to garner the 50 votes Republicans need to pass it. Moderate senators are concerned about cutting off coverage too quickly for those who gained it under the ACA, also known as Obamacare, while conservatives don’t want to leave big parts of the ACA in place.
As a nod to conservatives, the Senate bill would give states more leeway in opting out of the ACA’s insurance regulations through expanding the use of so-called “1332” waivers already embedded within the law, according to the draft proposal. States could use the waivers to make federal subsidies available even off the marketplaces — but they couldn’t go so far as to lift ACA protections for patients with preexisting conditions.
But it may prove trickier to get moderates on board. Senate leaders are hoping the big draw for them lies in the bill’s more generous income-based approach to insurance subsidies, which closely mirror the subsidies offered under Obamacare.
Subsidies are 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.
The Senate bill would also keep the ACA’s Medicaid expansion around for longer, gradually phasing it out over three years, starting in 2021.
During the 2016 presidential campaign, Donald Trump stumped on promises not to touch Social Security, Medicare, and Medicaid. Surprise! He lied to you. Medicaid will be gone, and Paul Ryan is coming for your social security and Medicare next.
Despite these shifts, moderates are likely to be turned off by how the bill cuts Medicaid more deeply than the House version. But the biggest cuts wouldn’t take effect for seven years, a time frame that could be more politically palatable for members like Sens. Rob Portman (R-Ohio) and Shelley Moore Capito (R-W.Va.).
Under the Senate draft, federal Medicaid spending would remain as is for three years. Then in 2021 it would be transformed from an open-ended entitlement to a system based on per capita enrollment. Starting in 2025, the measure would tie federal spending on the program to an even slower growth index, which in turn could prompt states to reduce the size of their Medicaid programs.
In a move that is likely to please conservatives, the draft also proposes repealing all of the ACA taxes except for its so-called “Cadillac tax” on high-cost health plans in language similar to the House version. Senators had previously toyed with the idea of keeping some of the ACA’s taxes.
Remember, for Tea-Publicans this is not about health care policy but is about freeing up money to give a massive tax cut to the wealthiest Americans.
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.
Yeah, I’m not buying it. This is a ruse. This will be decided in House v. Price before the Court of Appeals sometime in August, long before this bill is completed, if ever, later this year. The lower court ruled in favor of House Tea-Publicans that the cost sharing reduction (CSR) subsidies were not provided for in the ACA, and if President Trump elects not to defend against that ruling, he could kill the subsidies. There are a number of intervenors in the lawsuit, but the Court of Appeals is unlikely to rule for the intervenors when the principal litigants are in agreement. This is just about attracting votes now.
Even if the Senate measure does pass the upper chamber, there will have to be a reconciliation bill that can pass muster with the more conservative House and again in the Senate before any final legislation could be enacted. Tea-Publicans are only at the half-way point if the Senate passes this disastrous bill.
UPDATE: The 142-page bill, which is being described as a “discussion draft,” is online in its entirety here. (It is searchable.)