Senate GOP health bill would reshape Obama law

Secret Senate bill to replace Obamacare expected to come to light

US Senate Healthcare Bill to Cut Back on Medicaid Expansions

Senate Republicans on Thursday unveiled a "discussion draft" of their top-secret plan to repeal and replace the Affordable Care Act, bringing into the light of day the health care reform plan they drafted behind closed doors.

The bill would end Obama's tax penalties on people who don't buy insurance - effectively ending the so-called individual mandate - and on larger companies that don't offer coverage to their workers. The Senate proposal cuts off Medicaid expansion more gradually than the House bill but would enact deeper long-term cuts to the health care program for low-income Americans.

US Senate Republicans on Thursday unveiled a revamped health care plan aimed at fulfilling President Donald Trump's pledge to repeal Obamacare, but a revolt by four conservatives put the bill in immediate jeopardy.

The House approved its version of the bill last month. Tax cuts for the wealthiest among us take precedent over your affordable care.

McConnell must navigate a narrow route in which defections by just three of the 52 Republican senators would doom the legislation.

At the White House on Thursday, Trump expressed hope for quick action.

To appease conservatives wary of the longer period of expansion funding, the Senate bill introduces steeper cuts to the traditional Medicaid program.

The nonpartisan Congressional Budget Office said the House bill would cause 23 million people to lose coverage by 2026. McConnell's hoped-for vote within a week is likely to be met with significant resistance from Democrats, and some Republicans hinted they may not be willing to vote for the bill without more time to review the measure and gauge their constituents' feelings.

But the Senate measure, like the House bill, would phase out the extra money that the federal government has provided to states as an incentive to expand eligibility for Medicaid. Though they oppose the Republican House bill and are anxious about what the Senate majority is designing, they have had no actual Senate legislation against which to rail.

Republicans say that federal regulations unfairly restrict consumer choice. Republican senators from states that expanded Medicaid, such as Ohio's Rob Portman, want to extend that phase-out to seven years. The Senate version is, in some respects, more moderate than the House bill, offering more financial assistance to some lower-income people to help them defray the rapidly rising cost of private health insurance.

These tax credits, which about 8 million Americans receive, lower the cost of insurance plans that consumers can buy on HealthCare.gov, Covered California and other insurance marketplaces.

Now that the bill is public, a review from the bipartisan Congressional Budget Office is expected in the coming days. The program now gives states all the money needed to cover eligible recipients and procedures.

However, there are strict rules in place - what health policy experts call "guardrails" - stating that states getting those waivers must provide coverage that is "at least as comprehensive" as they would be otherwise, as the Centers for Medicare and Medicaid Services explains. States would also have to retain Obama's requirement that family insurance cover children up to age 26. The Senate bill would keep the House plan to send a fixed amount of money to states each year based on enrollment or as a lump sum block grant.

Cassidy said senators had also been told the legislation would continue funding cost-sharing subsidies made available to help low-income Americans under Obamacare "for a couple of years". They also identify trouble with Obamacare's insurance markets, which have been plagued by rising premiums and the departure of insurers (though the Trump administration is to blame for the latest palpitations, because it has threatened to cut off payments to insurers that are crucial to Obamacare's design).

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