Jun 22, 2017

Senate Republicans are about to find out what's in their bill

Lazaro Gamio / Axios

It's not just the rest of us who are in suspense. When Senate GOP leaders post the draft bill online this morning, it will be the first look at the details for a lot of rank and file Senate Republicans, too — aside from the leaks, of course.

Reality check: It's not a total mystery — Caitlin Owens has as good a read as anyone, and we're getting new details this morning from sources who have been briefed. And the bottom line is, it's not going to be a totally different than the House passed. It's going to be mostly the same structure, with changes at the margins.

"How can I discuss it when I don't know what it is?" Sen. John McCain asked after one last round of meetings yesterday afternoon. Sen. Susan Collins, a crucial swing vote, said she didn't know basic details about its rewrite of Medicaid, like how slowly it would phase out Medicaid expansion and how strict its spending limits would be. "Believe me, I'm even more eager than you are to see the bill," she told reporters.

The highlights of what we're likely to see:

  • Subsidies would still be available to help people buy health insurance, but only up to 350% of the federal poverty level starting in 2020, not the ACA's 400%.
  • It will have a four-year reinsurance program to help state insurance markets — though it might have to be passed separately, in the reauthorization of CHIP.
  • The ACA's cost-sharing reduction subsidies — one of the main things insurers say they need — would be funded through 2019. That may get challenged on the Senate floor, though.
  • States would get to waive some of the ACA's insurance regulations, through a beefed-up version of the law's "Section 1332" waivers. Pre-existing condition protections and coverage for young adults up to age 26 couldn't be waived.
  • Older customers could be charged five times as young adults, compared to three times as much under the ACA.
  • Medicaid expansion will be phased out more slowly than in the House bill, ending the expansion in 2024.
  • But Medicaid will still have per-capita caps — and with tighter spending limits than the House bill starting in 2025.
  • All ACA taxes would be repealed, except for the "Cadillac tax" on generous health insurance plans. That would just be delayed, as in the House bill.

Looking ahead: Democrats (and Republicans) will have a "virtually unlimited opportunity to amend it during the budget process on the floor" next week, per Senate HELP Committee chairman Lamar Alexander. So at least you can look forward to that.

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