Senate bill to repeal Obamacare cuts Medicaid, subsidies for the poor

The Senate plan negotiated in secret by Republican leaders and released Thursday would eliminate the Affordable Care Act’s insurance mandate, extensively cut Medicaid and reduce subsidies for low-income patients.

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The Better Care Reconciliation Act (BCRA), as the Senate bill is known, retains the structure of the American Health Care Act (AHCA), which the U.S. House passed in May. Now Republicans seek to reach a compromise between the two bills and send it to President Donald Trump for his signature, thereby preserving their campaign pledges to “repeal and replace” Obamacare.

Senate Republicans are aiming to bring the bill to a vote before the July 4 recess, a timeline causing concern among Democratic colleagues and some in the GOP, as well.

Reaction to the bill has been mixed, winning support from those within the administration, but facing criticism from the healthcare community. In addition, Republican Senate leaders released revisions to the bill on Monday in an attempt to shore up support from on-the-fence GOP Senators.

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma applauded the Senate for making progress “fixing the crisis in healthcare that has resulted from Obamacare.

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“Skyrocketing premiums, rising costs and fewer choices have caused too many Americans to drop their insurance coverage,” Verma said in a statement. “The Senate proposal is putting patients first and in charge of their healthcare decisions, bringing down the cost of coverage and expanding choices.”

But some health policy experts did not share that perspective.

“In broad strokes, the Senate bill is just like the House: Big tax cuts, big cut in federal health spending, big increase in the uninsured,” said Larry Levitt, senior vice president of the Kaiser Family Foundation, in a post on Twitter.

Next: Proposal highlights

Here are some highlights of the Senate’s proposal:

·      The BCRA, like the AHCA, would repeal the individual and employer mandate. Many healthcare experts believe this will lead to more uninsured patients. The AHCA required patients to have “continuous coverage” or they would pay a premium penalty.  After containing no such penalty in its initial draft, the BCRA includes a provision forcing patients who do not maintain continuous coverage to be penalized with a six-month waiting period before coverage begins.

·      Insurers must cover patients with preexisting conditions under the Senate bill. The AHCA eliminated this protection and instead sought to create high-risk pools to insure these patients.

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·      The BCRA provides tax subsidies to low-income Americans based on income. The AHCA provided subsidies based on age. The Senate version is similar to the Obamacare model, though the subsidies are less generous and patients would have to be poorer to qualify for them.

·      Both GOP bills would allow states to seek a waiver that allows them to sell plans that waive essential health benefits, including maternity and mental health care.

·      The BCRA unwinds the Medicaid expansion more slowly than the AHCA. It seeks to begin rolling back the Medicaid expansion over a few years with it concluding by 2024.

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·      In addition, the BCRA seeks to transform Medicaid from an open-ended entitlement program into a budgeted program. This means that spending on Medicaid patients would be capped based on how much federal and state governments decide to spend on the program.

·      The maximum contribution limit for health savings accounts will be increased under the BCRA.