Senate Republican leadership has released the long-awaited health care bill draft on Thursday, with the goal of dismantling former President Barack Obama's health care law.

  • READ: Senate Republican health care bill
  • GOP health care bill created behind closed doors
  • Some conservatives have vowed to oppose bill if it doesn't repeal Obama’s law
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The 142-page draft is designed to repeal Obama's Patient Protection and Affordable Care Act, or better known as Obamacare. The draft is also tailored to revamp Medicaid, the health care program for lower-income and disabled people.

In addition, it would repeal tax increases Obama’s law imposed on higher-income people and medical industry companies to pay for expanded coverage.

And one of the biggest changes that has been controversial about Obamacare is this: It would end the tax penalty Obama’s statute imposes on people who do not buy insurance — in effect, ending the so-called individual mandate.

What's in the bill?

The Senate's health care bill rolls back a number of the ACA's provisions while trying to keep the more popular ones.

MEDICAID

  • The bill continues to fund the Medicaid expansion created by ObamaCare until 2021. It then phases out the expansion over three years. The House version ended that support in 2020. The expansion allowed millions to get health care.
  • The Senate bill sends a fixed amount of money for Medicaid each year starting in 2020. States will have to choose between a fixed amount based on the number of people enrolled, or as a lump sum block grant.
    However, it shrinks the program even more over time by pegging the growth rate to standard inflation, not medical inflation, starting in 2025. States would likely have to cut enrollment, benefits or provider payments to meet the funding gap.

PREMIUMS SUBSIDIES

  • The bill tightens the eligibility criteria for ObamaCare's premium subsidies, starting in 2020. Those up to 350 percent of the poverty level would qualify for subsidies, as opposed to the 400 percent threshold under ObamaCare. It means fewer middle class people would get help.
  • The bill expands who can get subsidies by giving the states the option to use a waiver known as 1332 to let people not in exchanges get subsidies.

PRE-EXISTING CONDITIONS

  • Requires insures to cover pre-existing conditions and charge everyone the same. This is different from the House bill, which allowed states to remove those pre-existing protections.
  • Allows states to waive on what insurers must cover under essential health benefits. This means insurers can offer less comprehensive policies. 

TAXES

  • Nearly all Affordable Care Act taxes and fees would be repealed. The taxes were put in place to help fund the bill.
  • The so-called Cadillac Tax on generous employer plans would be repealed through 2025.

PLANNED PARENTHOOD

  • Cuts federal funding for one years as long as it continues to offer abortion services. Planned Parenthood currently does not use any federal funding for abortions. It receives federal grants for other services.

The CBO said it would have an estimate on the Senate's health care plan early next week. The Senate wants to have a vote on the bill by next Thursday, before the 4th of July recess.

Support and criticism

 

Sen. Majority Leader Mitch McConnell, R-Kentucky, is hoping to push the measure through the Senate next week. But its fate remains uncertain.

It faces uniform Democratic opposition. And at least a half-dozen Republicans — both conservatives and moderates — have complained about it.

Sen. Rand Paul, R-Kentucky and three other senators, Ted Cruz of Texas, Mike Lee of Utah, and Ron Johnson of Wisconsin, said they would oppose the current version of the bill, but were willing to accept it if changes were made.

Cruz, Lee and Johnson all worked on the bill.

The GOP health care bill has been talked about for weeks behind closed doors by a select few. The House-approved version of the legislation is meant to revamp health care.

The package represents McConnell’s attempt to quell criticism by party moderates and conservatives and win the support he needs in a vote he hopes to stage next week.

But senators have not been able to take a look at it.

Republican U.S. Sen. Ron Johnson, who is part of the group working on this bill, said he wants to make sure his peers have enough time to check it out.

"Somebody's got to write a bill. Now leadership will write a bill,” he said. “What I've told leadership very clearly is I'm going to need time and my constituents are going to need time to evaluate exactly how this will affect them."

The office of Sen. Marco Rubio, R-Florida, issued a guarded statement about the bill:

“Senator Rubio will decide how to vote on health care on the basis of how it impacts Florida. He has already spoken to Governor Scott, Senate President Negron and Speaker Corcoran about the first draft of this proposal. He has instructed his staff to share with state leaders the first draft and has asked them to run numbers and provide input on how this initial proposal would impact Florida’s Medicaid program and individual insurance marketplace. He has invited them to send staff to Washington next week to help us formulate changes and amendments to this proposal. He will continue to reach out for input and suggested changes from Florida providers, insurers and patient advocate groups.”

The White House has not released an official statement on the bill, nor as President Trump tweeted about the bill. During a technology event at the White House Thursday, the president said the bill needed "a little negotiation, but it's going to be very good."

Many are speaking out online criticizing the bill. Democratic U.S. Kamala Harris tweeted:

And U.S. Sen. Bill Nelson, D-Florida‏ posted this:

The biggest dissenter of all is probably the man considered the architect of the bill -- former President Barack Obama. Obama posted a long statement on Facebook, saying the legislation the Republicans have rushed through Congress, "without public hearings or debate" would not make people's lives better.

You can see the full statement via his Twitter post:

Some health groups already dissent

Medical groups are beginning to weigh in on the Senate Republican health care bill, and they have problems with the proposal.

The American Academy of Pediatrics says the bill would hurt children by scaling back Medicaid. Its president, Dr. Fernando Stein, says the plan was crafted without input from pediatricians and “would tear down” the progress the nation has made by achieving insurance coverage for 95 percent of children.

America’s Essential Hospitals, which represents more than 300 safety-net health facilities, says the version the Senate released Thursday “might be worse overall” than the House legislation and might lead to hospitals reducing services or closing.

The Association of American Medical Colleges says the Senate plan would leave millions of people without health coverage, and others with only bare-bones insurance plans.

What comes next for Senate Health Care Bill?

The Congressional Budget Office is promising an analysis of the bill by early next week.

There may be a Senate-wide vote before the 4th of July recess.

When the vote happens, there will be a debate and senators will have the opportunity to offer amendments to the bill.

Dozens of amendments are expected, and the Senate schedules back-to-back-to-back votes known on Capitol Hill as a "vote-a-rama."

McConnell has the option of offering the final amendment, which could contain changes aimed at placating GOP holdouts.

Since the Senate bill differs from the House health care measure, the legislation will either have to be reconciled in a House-Senate conference committee, which would require a second vote from both chambers.

Or, the House could simply approve the Senate version and send it to the president, though some Republicans may not be on board.