Parsing through the details of the GOP's health care bill

Jun 23, 2017

After a series of secretive meetings, Republican lawmakers in the Senate have finally revealed their plan to repeal and replace huge parts of the Affordable Care Act.

The 142-page bill, which includes cuts to Medicaid, would end the individual mandate set up by the ACA, which was a key component that kept the law functioning. The GOP plan would create federal tax credits to help Americans buy health insurance and would let states have more flexibility in deciding what services they want to keep and which they want to drop.

The bill was hashed out behind closed doors, a process that’s dismayed many lawmakers on both sides of the aisle, according to The Takeaway's Washington correspondent, Todd Zwillich.

“There are lots of frustrated senators saying they didn’t like the process of writing this bill, [but] none of them saying they would use their power to do anything about it,” says Zwillich.

Senate Majority Leader Mitch McConnell (R-KY) has pledged to have a vote on the legislation before July 4.

“I’m pleased that we were able to arrive at a draft that incorporates input from so many different members who represent so many different constituents, who are facing so many different challenges,” Sen. McConnell said Thursday.

The Senate bill looks a great deal like the House bill, which would leave 23 million more people without insurance over the next 10 years, according to the Congressional Budget Office. The CBO announced on Thursday that it will release figures on the Senate plan sometime early next week.

“At its core, this Senate plan is very similar to the House plan in its contours and shape,” Zwillich says. “What [the bill] is from 20 feet back is a huge cut to Medicaid, big tax decreases for wealthier people and medical device companies and other big companies in exchange for cutting insurance for lots of people who get help for it now and for poor people. That’s the broad outline of this plan.”

Though the Senate GOP’s bill repeals the individual mandate, the legislation maintains many of the ACA tax credits that have helped people buy insurance.

“Fewer people will qualify [for the tax credits],” Zwillich says. “Like in the House bill, older people around 58, 59, 62, who were lower income will certainly wind up paying a lot more for their health insurance if this bill passes in its current form.”

According to Zwillich, the changes to the tax credits would not go into effect until 2020. And like the House bill, the Senate’s legislation rolls back the Obamacare Medicaid expansion, which helped give insurance to more than 11 million people.

“[The Senate bill] would phase out the expansion of Medicaid that lots of states signed onto to give more people health care, beginning in 2020, and make deeper cuts after that,” says Zwillich.

On the campaign trail, President Trump promised to leave Medicaid alone.

Now, Republican lawmakers are trying to shift the language around these cuts.

“Medicaid’s not actually being cut from our perspective,” Republican Sen. Tim Scott told reporters on Thursday.

But that’s just not the case, Zwillich says.

“Medicaid is being cut — Sen. Scott there says that Medicaid’s not being cut from their perspective, but based on what we see right now in the bill there’s just no way that’s true,” Zwillich says. “After the 2020 drawback of Medicaid expansion, what this bill does in the out years, is it establishes a Medicare reimbursement rate for the states that’s pegged to inflation. ... That means the money available under this bill, for Medicaid in the out years, beyond 10 years, is even leaner, is even less, is even a deeper cut than what’s in the House bill.”

In recent weeks, some Republican senators have said they feel uncomfortable with Medicaid cuts being proposed. GOP Sen. Arthur Heller (R-NV), who is up for re-election, said Thursday that he has “serious concerns about the bill’s impact on the Nevadans who depend on Medicaid.”

“But there are going to be lots of opportunities for Mitch McConnell next week, when this bill’s on the floor, to make deals, to make amendments and to try to give senators things that they want to get their votes,” says Zwillich. “He may or may not succeed, he probably doesn’t have the votes right now, but even if he doesn’t have the votes right now, he can make deals to get there.”

This story originally ran on The Takeaway.  

From The Takeaway ©2017 PRI and WNYC