WASHINGTON — After weeks of secret negotiations, Senate Republicans on Thursday released their much-anticipated proposal to repeal Obamacare, unveiling a plan that would cut Medicaid and reduce penalties for not buying insurance.
But despite pledges to walk back key pieces of the House’s American Health Care Act, approved by that chamber last month, the Senate bill appears strikingly similar. Though Trump heaped public praise on the bill, Trump reportedly called it “mean” at a closed-door lunch. The nonpartisan Congressional Budget Office said the House plan would result in 23 million fewer people covered than under current law.
“From what I understand their bill tracks in many ways along the lines of the House bill,” said House Speaker Paul Ryan, R-Wis.
Among the notable changes between the two bills: The Senate policy-crafters elected to drop waivers allowing states to let insurers raise costs for people with preexisting conditions. That key piece was added to AHCA in an effort to entice conservatives to support the bill.
But the Senate version would actually have deeper cuts to Medicaid than the AHCA as part of Congress’ attempts to phase out the Obama administration’s expansion of the program to funnel more money to states to help low-income Americans.
The House version would end those subsidies in three years, a timeframe supported by more conservative members including Senate Majority Leader Mitch McConnell, R-Ky. But more moderate Senate lawmakers argued that more years were needed.
In an effort to forge a compromise, the Senate plan would end the extra Medicaid payouts after four years. But it would also begin capping the amount of money each state can receive from the program. Currently states can get funds from Medicaid to cover all eligible recipients.
Like the House bill, the Senate’s version would end the penalties levied on individuals who chose not to purchase insurance, a key piece of Obamacare. It would also roll back tax increases on wealthier Americans and health insurance companies.
Another key piece of Obamacare, subsidies helping poorer Americans purchase health insurance, would be reformed under both the AHCA and the Senate plan. The Senate plan, however, would factor in both age and income, whereas its House counterpart solely uses age.
The Senate legislation would also shift one of the key pieces of the House version, a $115 billion fund to help stabilize state marketplaces, into a separate bill reauthorizing the Children’s Health Insurance Program later this year.
But like the House bill, the Senate proposal defunds Planned Parenthood for a year, a potential deal breaker for Sens. Lisa Murkowski, R-Alaska, and Susan Collins, R-Maine. The Senate bill also prevents any insurance plans on the exchange from covering abortion except in the case of rape and incest and encourages private plans not to cover abortion as well.
McConnell said the bill was a needed improvement over Obamacare.
“Republicans believe we have a responsibility to act, and we are,” McConnell said on the Senate floor.
“Democrats imposed Obamacare on our country,” he said. “They said it would lower costs; it didn’t. They said it would increase choice, but of course, it didn’t.”
But many of McConnell’s members declined to comment as they left a closed-door meeting where the Republican senators were briefed on the proposal. Others said they were still reviewing the discussion draft presented Thursday morning, which stretched over 140 pages.
“Obviously we have a lot to look at,” Murkowski told reporters while leaving the meeting.
Democrats wasted no time, however, in blasting the proposal, referencing the president’s derisive comments about the bill and arguing it is little different from the AHCA, which 21 percent of Americans support, according to a Quinnipiac poll last month.
“The president said the Senate bill should have heart. But this bill is heartless,” Senate Minority Leader Charles Schumer, D-N.Y., said in a floor speech.
McConnell said on the floor that the Congressional Budget Office would score the Senate bill next week and then proceed to a debate and vote.
Additional reporting by Liz Goodwin.
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