Replacing Obamacare: Details released of Senate health care plan

Just hours after Senate Majority Leader Mitch McConnell, R-Ky., made public the bill aimed at revising the 2010 health law known as Obamacare, four conservative Republican senators headed by Rand Paul of Kentucky and Ted Cruz of Texas said “we are not ready to vote for this bill.”

“There are provisions in this draft that represent an improvement to our current health care system, but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs,” the four senators said in a joint statement.

By contrast, Sen. Lisa Murkowski, R-Alaska, one of the more moderate Republicans, said she would not support the bill because it eliminates federal dollars for Planned Parenthood, including money the organization uses for women’s preventative health such as mammograms and Pap smears.

The divisions expressed by Republicans Thursday were a sign that McConnell faces a difficult job persuading at least 50 of the Senate’s 52 Republicans to vote for the bill, which would allow Vice President Mike Pence to break a tie.

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McConnell and his allies might have pushed for a more bipartisan approach which could have a number of Democrats. But any bipartisan bill passed by the Senate would be too moderate to win approval from the Republican-controlled House, which passed its own version last month. Republicans have set a goal of passing the bill by the time the Senate goes home for its July 4 recess.

Medicaid cuts

The bill does not scrap Obamacare, but it scales back the law’s efforts to provide health coverage for millions of low-income people. In particular, the Senate Republican leadership bill would end by 2024 an expansion of Medicaid, the joint federal and state program which provides health cover to low-income people.

Instead, the Senate bill would continue expanded Medicaid dollars through 2021 and then gradually phase out the program in 2024. By contrast, the House version ends expanded Medicaid in 2020.

Both bills would have a major impact in Ohio, where Gov. John Kasich took advantage of hundreds of billions of federal dollars to extend coverage to people who in the past had not qualified for Medicaid but did not earn enough money to qualify for federally subsidized individual insurance policies created by Obamacare.

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Kasich – a Republican – expressed “deep concerns with details of the U.S. Senate’s plan to fix America’s health-care system and the resources needed to help our most vulnerable, including those who are dealing with drug addiction, and chronic health problems and have nowhere else to turn.”

Sen. Rob Portman, R-Ohio, who is one of the key votes Republicans need to pass the health-care bill, earlier this month backed a plan to slowly phase out Medicaid expansion by 2027. It was unclear whether the faster phase out would cause Portman to oppose the bill.

In a statement late Thursday, he said he looks forward to examining the proposal carefully, but said he has “real concerns” about the Medicaid policies in the bill. The bill includes a one-year $2 billion provision to provide grants to fight the opioid epidemic.

“If the final legislation is good for Ohio, I will support it,” he said. “If not, I will oppose it.”

Sen. Sherrod Brown, D-Ohio, like all Senate Democrats, will oppose the bill.

“Instead of raising prices on people over 50 and working families, we should be working together to lower costs, fight the opioid epidemic and make healthcare work better for everyone,” he said.

Individual mandate

The Senate GOP bill also alters Obamacare’s requirement that people without insurance be required to buy a plan or face a fine. Obamacare provided tax credits for families of four earning between $34,000 and $98,400 a year to buy individual plans through federal and state marketplaces known as exchanges.

The bill also allows states to seek federal permission to allow insurance companies to offer individual plans that do not include Obamacare’s 10 essential benefits, such as hospitalization, maternity and newborn care, prescription drugs and laboratory services.

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The Senate bill, however, differs from the House on pre-existing conditions. Their bill would maintain Obamacare protections for those with pre-existing conditions, while the House would’ve allowed states to remove such protections and given insurers more pricing flexibility.

Like the House bill, the Senate Republican bill would sweep away most of the tax increases approved in 2010 to finance the expansion of health care.

The nonpartisan Congressional Budget Office concluded the bill approved last month by House Republicans would decrease the number of people without insurance or government health coverage by 24 million by 2026. A CBO analysis of the Senate version of the bill is expected to be released sometime early next week.

Although health care amounts to about one-sixth of the nation’s gross domestic product, neither the House nor Senate bill does not directly impact employer-based health care, which is how most Americans receive health care. But should the Republicans pass a bill, it could become a model for future employer health-care plans, with employer plans offering benefits that mirror what is offered under the bill.

About 155 million Americans are insured by their employers, 55 million by Medicare, which pays health costs for the elderly, and another 74 million by Medicaid, the joint federal and state program that provides health care for low-income people and the disabled.

Even as senators such as Paul and Cruz released statements opposing the bill, Barry Bennett, a former senior adviser to President Donald Trump’s campaign, predicted the bill would pass, saying “my money is always on Mitch McConnell. He doesn’t lose a lot of these.”

“Now the buy-offs begin,” Bennett said. “Some people will want more money for opioids. Some people will want more money for Medicaid. They probably are all going to get it.

“You are going to lose two,” Bennett said. “My guess is Murkowski is one of them and Rand Paul is the other. And then it passes.”

(Catherine Candisky contributed to this report.)