'Skinny' Senate Obamacare replacement keeps subsidies, drops mandate and leaves Medicaid untouched
Senate Republicans Thursday night unveiled their "skinny" bill that will pave the way for the House and Senate to move forward on repealing the Affordable Care Act.
The Health Care Freedom Act permanently eliminates the individual mandate and cancels the employer mandate until 2024. It also allows states to seek 1332 waivers, giving them more flexibility in the types of plans that can be offered.
The so-called "skinny" replacement bill doesn't allow states to change essential health benefits in their waivers, and states must show how they could cover about as many people as are now in the individual market after the changes. The waivers would last for eight years, protecting them from a change in power in a state capital.
The Congressional Budget Office estimated that the bill would result in 16 million people losing coverage by 2026. The analysis, which was done in conjunction with the Joint Committee on Taxation also projected that premiums would jump 20% relative to current law in all years between 2018 and 2026.
Senate GOP leadership made many of those changes to previously proposed waiver language after the Senate parliamentarian ruled it violated the chamber's budget rules and could not pass by a 51-vote majority.
The skinny bill also forbids Medicaid funding for Planned Parenthood and adds money to community health centers to offer more gynecological services.
Health Savings Accounts would have higher limits for the next three years, allowing people who can set thousands aside to save on taxes. The limit would roughly double, to more than $7,000 for an individual.
It cuts money from the Prevention and Public Helath Fund to reach budget targets, necessary under Senate budget reconciliation rules.
The American Medical Association Thursday night urged senators to reject the skinny repeal bill in favor of a bipartisan ACA replacement.
"Action is needed to address problems in the individual insurance market, but the so-called 'skinny' bill is a toxic prescription that would make matters worse," said AMA president Dr. David Barbe in a statement. "Eliminating the individual mandate will lead to adverse selection, triggering higher premiums and further destabilizing the individual market. The stated goal was to advance policies to lower premiums, but the 'skinny' bill would do the exact opposite, harming patients across the country."
Less than two hours before an expected vote on the bill, it wasn't clear if it would have the support of 50 Republicans, who could then pass it with a tie-breaking vote from Vice President.
Some senators denounced the bill before it was made public. Sens. John McCain (R-Ariz.), Lindsey Graham (R-S.C.) and Ron Johnson (R-Wis.) said the slimmed-down bill would "destroy" the health insurance marketplace and called for House Speaker Paul Ryan to guarantee the Senate proposal will go to conference rather than straight to that chamber's floor.
Ryan initially responded that the House was willing to work in conference with the Senate on the skinny bill, and further reassured the wary senators of his commitment in a phone call. Graham and Johnson have said since that they will vote for the bill as a way forward, while McCain called Ryan's initial statement "not sufficient."
Not all Republicans support moving forward with a conference. Sen. Mike Rounds (R-S.D.), said he was concerned that a conference committee act fast enough that insurance "companies recognize that there is a plan to stabilize the markets."
Just three defections would doom the bill. Four Republican senators were silent on their planned votes.
Nearly all the taxes that fund Obamacare remain in the bill, though the medical device tax would be postponed for three years.
Shortly before the bill was unveiled, 52 senators voted to permanently put off collection of the so-called cadillac tax on generous health plans.
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