With Health Plan, GOP Would Drastically Cut Medicaid And Fundamentally Reshape Program
On Thursday, Republican leaders released the Better Care Reconciliation Act, their version of repeal-and-replace legislation for the Affordable Care Act. Here's a look at what's in it, what's coming next, and who opposes the plan.
The New York Times:
Senate Health Care Bill Includes Deep Cuts To Medicaid
Senate Republicans, who for seven years have promised a repeal of the Affordable Care Act, took a major step on Thursday toward that goal, unveiling a bill to make deep cuts in Medicaid and end the law’s mandate that most Americans have health insurance. The 142-page bill would create a new system of federal tax credits to help people buy health insurance, while offering states the ability to drop many of the benefits required by the Affordable Care Act, like maternity care, emergency services and mental health treatment. (Pear and Kaplan, 6/22)
The Wall Street Journal:
Senate GOP Health Bill Would End ACA Penalties, Cut Taxes On High Incomes
The bill would reverse the ACA’s expansion of Medicaid, a move that could affect millions of people, and would for the first time limit states’ overall Medicaid funding from Washington. It also would eliminate the requirement in the 2010 law that most Americans sign up for health insurance, and provide instead less-robust tax credits than the ACA to help people afford insurance. It would repeal hundreds of billions of dollars in taxes on businesses and high-income households and retroactively cut taxes on capital gains. (Armour, Peterson and Radnofsky, 6/22)
The Washington Post:
How The GOP Would Cut Billions More From Medicaid With A Single Letter
Already, the version of the bill the House passed last month included drastic reductions in Medicaid outlays of about $834 billion over 10 years. GOP senators' own version of the bill, which they made public Thursday, could go even further over the long term. Both the House and Senate bills aim to set a per-person cap on Medicaid spending in each state. That cap would adjust annually to take into account inflation. Through 2025, both bills would adjust the cap based on a measure of how rapidly medical costs are expanding — a measure known as the CPI-M. Starting in 2025, however, the Senate bill would change the formula, instead funding Medicaid based on a measure of how rapidly all costs are rising (technically, the Consumer Price Index for urban consumers, or just CPI-U). (Ehrenfreund, 6/22)
The Washington Post:
How The GOP Health-Care Bill Would Address One Of Obamacare’s Big Problems — But Could Cause An Even Bigger One
The Senate bill would restructure the way the Affordable Care Act provides insurance subsidies. Currently, there's a maximum and a minimum level of income at which a person qualifies for federal help. The Senate bill would remove that minimum, meaning that everyone who makes less than 350 percent of the federal poverty level would qualify for insurance subsidies. That change is aimed at one outcome of Obamacare that nobody — neither critics nor supporters — ever intended. As planned, everyone making less than the minimum required for subsidies would qualify for Medicaid, which the law sought to expand nationwide. But when the Supreme Court gave states more freedom to decide whether they would expand the program, many states didn't. That left a coverage gap in many states and left approximately 2.6 million people in a maddening paradox: They made too much money to qualify for Medicaid but too little money to qualify for insurance subsidies. Without federal help, most are unable to afford health insurance and go without. (Johnson, 6/22)
NPR:
Senate Republicans Reveal Long-Awaited Obamacare Overhaul
"That's a big deal. It's a big shift," said John Corlett, president of the Center for Community Solutions, who also served as a director of Ohio's Medicaid program. "It means billions of dollars less in federal aid to states for their Medicaid programs." (Kurtzleben, 6/22)
The Associated Press:
How The Senate Health Bill Compares To House,' Obamacare'
The bill's impact on personal health care costs would be uneven: Premiums would likely go down for younger people, but older people would pay more. Out-of-pocket costs to cover insurance deductibles and co-payments would go up. For those who believe the government is too involved in health care, the Senate bill stands as an overdue course correction. But those who believe health care is a right will see it as a step back. (Alonso-Zaldivar, 6/23)
The Wall Street Journal:
Assessing The Impact Of The Senate GOP Health Bill
The ACA’s protections for people with costly pre-existing medical conditions would stay in place. That means insurance companies couldn’t deny people with pre-existing conditions health coverage or charge them higher premiums. Under the House bill, insurers in some states could charge sicker people higher premiums, which conservative House lawmakers argued could help lower premiums for other people. But Senate lawmakers rejected that idea. States could get waivers to roll back benefits that must now be required under the ACA, and that could leave people with certain medical conditions paying more for their coverage. (Hackman, 6/22)
The Washington Post:
Limited Coverage, Subsidies For Some In Senate GOP’s Proposed Health-Care Overhaul
The Senate Republicans’ Better Care Reconciliation Act would significantly affect health coverage for many Americans, whether through the individual insurance market or Medicaid. Here are a few examples of how. ... The Senate bill provides $2 billion in fiscal 2018 for substance abuse treatment and recovery, but eventually it would take away much more by rolling back Medicaid expansion in 2020, capping federal payments to states and allowing them to change what qualifies as an essential service. Right now, all insurers and Medicaid must offer drug treatment benefits that are on par with their benefits for physical conditions. If this man’s state decided that substance abuse treatment was no longer an essential service, coverage for that care could be eliminated. (McGinley, Bernstein and Sun, 6/22)
The Wall Street Journal:
Health Bill Includes Opioid Funding, But May Not Satisfy Some GOP Senators
The Senate GOP’s health-care bill would offer $2 billion for opioid addiction treatment for one year, falling short of the $45 billion over 10 years some Republican senators wanted. The funding’s inclusion in the Senate version of the health-care overhaul comes after weeks of protest from House and Senate Republicans who feared steep cuts to Medicaid would worsen an already growing opioid crisis, with Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia leading the push. (Nunn, 6/22)
The Washington Post:
Senate GOP Bill Would Gut Critical Public Health Funding This Fall
The health-care bill that Senate Republicans released Thursday would eliminate critical funds for core public health programs that make up about 12 percent of the budget for the Centers for Disease Control and Prevention. The money supports programs to prevent bioterrorism and disease outbreaks, as well as to provide immunizations and screenings for cancer and heart disease. (Sun, 6/22)
The Wall Street Journal:
Planned Parenthood Restriction Could Pose Problem For Centrist Senators
The Senate health bill released Thursday strips federal Medicaid funding from Planned Parenthood Federation of America for one year and tightens restrictions on abortion coverage, creating potential sticking points for centrist senators. The Planned Parenthood measure, which mirrors a provision in the House version of the bill, would disqualify the network of women’s health clinics from receiving federal Medicaid funding, stripping the organization of hundreds of millions of dollars and potentially forcing some clinics to shutter. (Hackman, 6/22)
The Associated Press:
Senate GOP Health Bill: Tax Cuts For Rich
Senate Republicans' new health bill cuts taxes by nearly $1 trillion over the next decade, mostly for corporations and the richest families in America. It uses a budget gimmick to comply with Senate rules against adding to the federal government's long-term debt. (6/23)
USA Today:
Senate Health Care Bill: Here's How It Would Affect You
The bill would sunset in two years subsidies for people who purchase insurance on an exchange. Most of the more than 6 million Americans benefiting from the help may not be aware they’re getting it, since the subsidy goes directly to the insurer who then lowers the cost-sharing requirements for a plan. Without the subsidies, insurers would need to raise rates an estimated 20% to make up for the loss, experts have estimated. But the bill also includes funding for states to reduce insurance costs in other ways. (Groppe, 6/22)
The Washington Post:
Senate Republicans’ Claim Of Saving Individual Health Insurance Markets Could Prove Hollow
Republicans have vowed for months to undo the Affordable Care Act and stave off the collapse of the nation’s most fragile health insurance markets, which serve people who buy coverage on their own. In the Senate, that turns out to be a short-term goal. Legislation that the Senate’s GOP leaders finally disclosed on Thursday would keep billions of dollars flowing — but only for two years — to health plans that have been begging for continued help with the expense of millions of lower-income customers in ACA insurance marketplaces. After 2019, the payments would stop. (Goldstein, 6/22)
The Wall Street Journal:
What To Expect Now That The Senate Health Bill Has Been Released
Senate aides expect that Majority Leader Mitch McConnell (R., Ky.) will bring the health bill as soon as Tuesday, shortly after the CBO score has been released. The first vote will be on a motion to proceed to the bill, which would need a simple majority to advance the bill. That means Mr. McConnell needs at least 50 votes, with Vice President Mike Pence on hand to break a tie. (Peterson, 6/22)
The Associated Press:
McConnell Faces Hunt For GOP Votes For Senate Health Bill
Shortly after the 142-page bill was distributed, more than a half-dozen GOP lawmakers signaled concerns or initial opposition. McConnell, R-Ky., has little margin for error: Facing unanimous Democratic opposition, "no" votes by just three of the 52 GOP senators would sink the legislation. McConnell, eager to approve the legislation next week, indicated he was open to changes before it reaches the Senate floor. But he said it was time to act. "No amount of 11th hour reality-denying or buck-passing by Democrats is going to change the fact that more Americans are going to get hurt unless we do something," he said. (Fram and Alonso-Zaldivar, 6/23)
The Associated Press:
Senate GOP Unveils 'Obamacare' Overhaul, But Not All Aboard
Four conservative GOP senators quickly announced initial opposition to the measure and others were evasive, raising the specter of a jarring rejection by the Republican-controlled body. But Senate Majority Leader Mitch McConnell, R-Ky., indicated he was open to discussion and seemed determined to muscle the measure through his chamber next week. (6/22)
Los Angeles Times:
Republican Senators Seek Changes In Obamacare Repeal Bill They Can All Agree On. It Won't Be Easy
Within just a few hours, four key conservative senators — Ted Cruz of Texas, Mike Lee of Utah, Ron Johnson of Wisconsin and Rand Paul of Kentucky — jointly announced they could not possibly vote for the bill as is, unless it more fully guts the Affordable Care Act. Likewise, centrists withheld their support unless they can push the bill the other way, as they mull the fallout from leaving millions more Americans uninsured. (Mascaro, 6/22)
Politico:
Winners And Losers From The Senate Repeal Bill
The Senate plan, like the House bill, would allow insurers to charge their older customers up to five times as much as younger customers for the same health plan. That’s an expansion of the so-called age band in Obamacare, which allows insurers to charge older customers no more than three times as much as younger ones. In two years, the Senate plan would also eliminate a key subsidy program that helps cover out-of-pocket medical bills for low-income consumers. (6/22)
The Washington Post:
Republicans’ New Obamacare Repeal Bill Has A Lot For Insurers To Like And For Hospitals To Hate
Major health care industry groups largely fell into two camps on Thursday when Republicans released their Affordable Care Act repeal: There were those groups that criticized the bill, and those that preferred to say nothing at all. For the health insurance industry, the bill is a mixed bag. The major trade association for health insurers, America's Health Insurance Plans, declined to issue a specific response to the bill, saying they were still evaluating it. But the proposed legislation contains several provisions that the industry has been fighting for, including a tax repeal worth $145 billion over 10 years to the industry and a guarantee that billions of dollars of federal subsidies would be paid in 2018 and 2019 to stabilize plans in the Affordable Care Act's marketplaces before they are phased out. There are also two funds, adding up to $112 billion over a decade, to stabilize the market and make insurance more affordable. (Johnson, 6/22)
The Wall Street Journal:
Big Pharma Plays It Safe On Senate Health Bill
The branded-drug industry, which was pilloried by conservatives for supporting then-President Barack Obama’s health-care overhaul, is playing it safe as Republicans move to undo the measure. The Pharmaceutical Research and Manufacturers of America, the trade association for brand-name drug companies also known as PhRMA, has avoided taking a position on the Republican bill released Thursday. (Rockoff, 6/22)
The Washington Post:
‘Meanness At The Core:’ Obama Jumps Back Into Political Fray To Slam Trump, GOP On Health Care
The plan is “not a health care bill,” Obama declared in a 939-word message to his nearly 53 million followers on Facebook. “It’s a massive transfer of wealth from middle-class and poor families to the richest people in America.” The 44th president did not mention his successor, Donald Trump, but his scathing criticism and urgent tone — imploring his supporters to speak out against the “fundamental meanness at the core of this legislation” — set up a direct public fight with the current White House occupant over the future of the nation’s health care system. (Nakamura, 6/22)