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J. Scott Applewhite / AP

The Senate health care bill is scheduled to be released tomorrow, and we're hearing the state of play is extremely fluid. What we reported yesterday is changing today, and different people have different understandings of what's in the bill. But one big thing that's in play: Republicans may take a different route to give states flexibility on the Affordable Care Act's insurance regulations.

Here's the latest on what we're hearing:

  • The bill would fund the ACA's cost-sharing subsidies — a key sticking point for insurers — through 2019.
  • It also would provide a four-year reinsurance program to help states stabilize their marketplaces.
  • Subsidies would be available to people making up to 350 percent of the federal poverty limit — down from 400 percent under the ACA. That includes people under 100 percent of the federal poverty limit, who currently don't receive subsidies under the ACA (the law assumed this population would be on Medicaid).

Market reforms

  • The House's optional state waivers probably will not be included in tomorrow's draft bill (yesterday, we reported that the plan was to include essential health benefit waivers, per several senior GOP aides). The House bill allowed states to waive the Affordable Care Act's essential health benefits and its ban on charging higher premiums to sick people.
  • But the Senate gives much greater flexibility to the ACA's existing state waivers (for wonks, 1332 waivers), and expedites their approval. The ACA laid out strict conditions for what the waivers could do, and the GOP bill would loosen these — which could be a different means to the same end.
  • What would be waivable:Essential health benefitsActuarial value, or the requirement that plans cover a certain percentage of an enrollee's health care costsThe definition of a quality health planNot the ban on charging sick people higher premiums than healthy people, nor the requirement that insurers sell plans to people with pre-existing conditions

Tax Credits

  • Aides are fairly certain they won't be able to create a new tax credit for people buying on the individual market that includes the pro-life Hyde amendment, per Senate budget rules.
  • The backup plan is to leave the current ACA premium subsidy structure in place, but to scale it back.
  • However, the bill will also include an insurer stabilization fund, like the House bill. This probably will be funneled through the Children's Health Insurance Program, which does contain the Hyde amendment. Thus the stabilization fund can't be used to cover abortions.
  • Since most plans will use the stabilization fund, they won't be allowed to cover abortions — a roundabout way of including pro-life protections.
  • What's unclear is whether tomorrow's draft will create a new tax credit structure with Hyde amendment protections, which will probably be stripped out before the vote on the bill, or whether it'll skip straight to including the revised ACA subsidy structure.

Medicaid

  • We haven't heard anything new here today. Still a lower growth rate than the House beginning in 2025 and a three-year glide path for phasing out Medicaid expansion.
  • It will also let states choose the base amount for their per capita caps based on eight consecutive quarters.

Go deeper

Updated 2 hours ago - Health

NYC firefighters union urges members to defy mayor's vaccine mandate

New York City Mayor Bill de Blasio. Photo: Michael M. Santiago/Getty Images

The president of New York City's firefighters union told reporters Wednesday that he's advised unvaccinated members to ignore Mayor Bill de Blasio's COVID-19 vaccine mandate for city workers, per Reuters.

Why it matters: Under de Blasio's order that's due to take effect Friday, unvaccinated city employees would be placed on unpaid leave. But Uniformed Firefighters Association head Andrew Ansbro said he told members that "if they choose to remain unvaccinated, they must still report for duty," according to Reuters.

4 hours ago - Health

Study: Common antidepressant guards against COVID hospitalization

A COVID-19 intensive Care Unit in Rio De Janeiro, Brazil on May 27, 2021. Photo: Fabio Teixeira/Anadolu Agency via Getty Images

The readily available antidepressant fluvoxamine significantly reduced COVID-related hospitalizations, according to a large study published Wednesday.

Why it matters: The clinical trial suggests that a cheap, readily available drug could dramatically reduce serious illness and death when prescribed early.

By the numbers: Catholics, Biden and abortion

Expand chart
Reproduced from Pew Research Center; Chart: Axios Visuals

President Biden — the second Catholic U.S. president — will meet with Pope Francis at the Vatican on Friday, as some church leaders debate whether to deny Holy Communion to politicians who support abortion rights.

By the numbers: Overall, two in three U.S. Catholics believe Biden should be allowed to take Communion despite his stance on abortion, according to polling by Pew Research Center.