Details of the Senate’s “draft” health care bill, which Republicans were set to unveil Thursday after weeks of secretive negotiations, have finally leaked—and from the sound of things, Mitch McConnell and his cohorts have written a morally appalling piece of legislation that many conservatives will nonetheless find deeply underwhelming.
According to the Washington Post, which cites “a discussion draft circulating Wednesday afternoon among aides and lobbyists,” the plan looks much like the Obamacare repeal legislation passed last month by the House, with a few key depatures. Here's a brief rundown:
1) Instead of providing Americans tax credits to buy insurance based on their age, as the House bill does, the Senate would offer them based on “financial need”—which is more or less how Obamacare works. But under the GOP’s proposal, fewer Americans would qualify for help. Under the Affordable Care Act, households can receive insurance subsidies if they earn up to 400 percent of the poverty line. Senate Republicans would lower that threshold to 350 percent. Subsidies will also be smaller for those who still qualify.
In short, it sounds like McConnell’s working group is keeping Obamacare's subsidy structure but making it stingier. It is unclear who this will please.
2) The Senate bill eliminates all of Obamacare’s taxes except the “Cadillac tax” on expensive health plans. This will please the medical device makers, investors, high earners, and insurance companies that were taxed by the ACA.
3) It rolls back Obamacare's Medicaid expansion “more gradually than the House bill,” according to the Post, though how much more gradually is unclear. Senate Republicans have been haggling over whether to phase out the expansion over as little as three years or as many as seven—but the final outcome would be the same either way. Meanwhile, it sounds like the Senate is going to run with its plan to impose even more draconian spending cuts on Medicaid over the long term by capping per-patient spending, then increasing funding more slowly each year than the House would. (I wrote about that plot earlier this week.)
4) What about consumer protections? The House bill notoriously allowed states to opt out of Obamacare's insurance regulations, such as rules barring carriers from discriminating against patients with pre-existing conditions or requiring them to cover certain services. Sensing that it might be politically suicidal to strip cancer and heart patients of their protections, Senate moderates have reportedly resisted going down that path. Right now, it's unclear who won the argument.
Axios reports that the Senate will instead give states more leeway to use Obamacare’s existing waiver system, allowing them to jettison some of the law’s coverage requirements—though not the popular protection for pre-existing conditions. This approach would encourage carriers in states with laxer rules to limit their offerings to minimal plans that would be largely useless to people with extensive health problems.
5) The Senate bill would kill funding for Planned Parenthood but wouldn't bar the government from subsidizing private insurance that pays for abortions, which will infuriate religious conservatives.
So, to review: The Senate bill keeps Obamacare’s subsidy structure in place while paring back eligibility, guts Medicaid more slowly but more severely than the House bill, and still lets states drop essential consumer protections, although not as many as the House. But fear not. “Aides stress that the GOP plan is likely to undergo more changes in order to garner the 50 votes Republicans need to pass it,” the Post reports. Surely it will only improve as McConnell frantically tries to whip his caucus next week, right?