Last week, President Donald Trump privately instructed senators to make their Obamacare replacement bill less “mean” than the House of Representatives’ version. Based on the few known details of the Senate bill, it appears the president just barely got his wish.
Because Republicans have insisted on writing their version of the American Health Care Act in unprecedented secrecy, little concrete information about the bill has emerged. But reports started to leak out on Wednesday evening. Here’s what we know so far:
Medicaid: The Affordable Care Act expanded Medicaid eligibility to cover single, nondisabled adults with incomes just above the poverty line in several states. Right now, about 10 million people across 31 states and the District of Columbia are covered under that expansion, and the government doesn’t cap the dollar amount states can spend on each beneficiary or service.
The House bill would roll back that expansion by limiting the amount of money the federal government can use to reimburse states for Medicaid, and the Senate bill would do the same, according to the Associated Press. But while the Senate version reportedly proposes taking longer to do so — potentially taking up to seven years, instead of three — its method of calculating growth will ultimately leave states with even less federal funding for Medicaid.
Tax credits: One of the House bill’s most controversial provisions was its proposal to eliminate the Affordable Care Act’s income-based tax credits. Instead, tax credits would be allocated based on age — for instance, people in their 20s would pay $2,000, while people older than 60 would pay $4,000. The Congressional Budget Office predicted that such credits would lead Americans’ out-of-pocket costs to spike. The Senate’s bill will let the tax credits remain connected to income, the Washington Post reports.
Abortion: The House’s version banned federally-subsidized health plans from covering abortion care, a move critics said would essentially end private health insurance coverage of abortion. The Senate has dropped that provision, according to the Washington Post.
Still, that doesn’t mean the new bill is friendly to women’s health. Right now, Planned Parenthood receives reimbursements through Medicaid and Title X, though none of that money can be used for abortions. The Senate bill, like the House’s, reportedly strips that funding from Planned Parenthood. That will likely leave low-income women — 65 percent of whom rely on public health programs — without access to reproductive care.
Other aspects of the bill remain shrouded in secrecy — including its stance on the Affordable Care Act’s 10 so-called “Essential Health Benefits,” like maternal care and addiction treatment, that plans are currently required to cover. (Republican debate over those categories of care torpedoed House Speaker Paul Ryan’s first attempt to pass the American Health Care Act.)
It’s also unclear what the Senate plan will do about people with preexisting conditions; right now, insurance companies can’t deny them coverage or charge them more. But even if the Senate bill keeps that provision, losing the essential health benefits go would make the pre-existing conditions guarantee meaningless since insurance companies could just choose not to offer plans covering certain conditions.
Republican Senate Majority Leader Mitch McConnell of Kentucky is expected to present a draft of the bill to Republican senators Thursday morning, as he purportedly wants senators to vote by July 4. The Congressional Budget Office, which estimated that the House bill would leave 23 million more people uninsured by 2026, will likely score the Senate version Monday.