Health and Science

Here are the details of Senate Republican Obamacare replacement bill

Key Points
  • The bill would significantly change how the federal government subsidizes individual health plans and funds Medicaid
  • GOP leaders want to have a vote on the bill before the Fourth of July recess.
  • The House's own version of a health-care bill is deeply unpopular.
Former Medicare administrator: Millions will still lose coverage under Senate health-care bill
Former Medicare administrator: Millions will still lose coverage under Senate health-care bill

Senate GOP leaders on Thursday finally released their secret health-care reform bill, which would repeal Obamacare taxes, restructure subsidies to insurance customers, and both phase out Medicaid's expansion program and cap Medicaid spending.

Republicans plan to bring the controversial bill that was drafted in secret to a quick vote next week, but face potentially fatal opposition to it from several members of their own caucus.

The 142-page bill, if passed into law, would sharply reduce financial aid that currently helps millions of people obtain health coverage, while at the same time offering a tax break to primarily wealthy Americans to the tune of hundreds of billions of dollars. And it would loosen rules in a way that could lead to states allowing insurers to offer less-generous health plans.

The bill would repeal, retroactive to the beginning of 2016, the Obamacare rule requiring most Americans to have some form of health coverage or pay a tax penalty fine. That repeal is expected to sharply increase the number of people who don't have insurance, which could in turn lead insurers to raise premiums.

And it would repeal, retroactively to the beginning of 2016, the "employer mandate," which requires large employers to offer health insurance to workers or be fined.

Read the entire bill here

The bill also would continue for at least two years to offer reimbursements to health insurance companies for subsidies that reduce out-of-pocket costs for low income customers of Obamacare plans. But those subsidies would end in 2020, which would increase deductibles and other out-of-pocket health expenses for millions of customers.

The federal government's share of funding for Medicaid, which is jointly run with individual states, would fall over the course of seven years to end up at around 57 percent of the cost of that program, which offers health coverage to the poor.

Under Obamacare, the federal government had guaranteed that its funding for adults newly eligible for Medicaid because of the Affordable Care Act would fall to no lower than 90 percent of their costs. That expansion program would begin being phased out in 2021, and fully repealed by three years later.

Tax credit based on income for GOP health bill
Tax credit based on income for GOP health bill

In another cost-cutting move, the bill would lower the maximum income level a household could have to still qualify for federal subsidies that help reduce the premiums people pay for enrollment for individual health plans. Obamacare currently bars subsidies to families that earn more than 400 percent of the federal poverty level. The new bill would reduce that cap to 350 percent of the poverty level.

Younger people, as a group, would end up paying less of a share of their income toward their individual health plans under the bill in comparison to what they pay now under Obamacare, while older people as a group would end up paying a larger share of their income.

Health plans that offer abortion services would not be eligible for the subsidies, according to the draft released Thursday.

The federal government also would end up spending less money subsidizing people's insurance purchases by changing how the value of those subsidies are calculated. The bill would use a less-expensive type of individual health plan to calculate those subsidies, as opposed to the pricier plan used under Obamacare.

The bill also seeks to repeal, to the start of 2017, the 3.8 percent tax on net investment income.

The Trump administration is expected to back the bill, which most GOP senators were learning the details of during a meeting Thursday morning. The bill is named the "Better Care Reconciliation Act of 2017."

"It's going to be very good," President Donald Trump said about an hour after the bill's release. "A little negotiation, but it's going to be very good." Trump did not elaborate.

The House's version of the bill, dubbed the American Health Care Act, is broadly unpopular among the public, and had been reportedly called "mean, mean, mean," by Trump during a meeting with senators. Weeks earlier, Trump and House members who voted for the ACHA celebrated its passage in the Rose Garden of the White House.

A new NBC News/Wall Street Journal Poll released Thursday found that just 16 percent of Americans thought the House bill was a good idea, with 48 percent saying it is a bad idea.

"In broad strokes, the Senate bill is just like the House: Big tax cuts, big cut in federal heath spending, big increase in the uninsured," tweeted Larry Levitt, an Obamacare expert at the Kaiser Family Foundation.

"Under the Senate bill, low-income people would pay higher premiums for bigger deductibles," Levitt said.

He had noted on Twitter on Wednesday that "A 60 year-old at 351% of poverty currently gets a premium subsidy of $5,151 per year on average." The Senate bill would eliminate all of that federal financial aid if it becomes law.

Obamacare collapsing right before our eyes: Sara Fagen
Obamacare collapsing right before our eyes: Sara Fagen

Senate GOP leaders want to have a vote on the bill by late next week, before Congress' Fourth of July recess. They do not plan to hold any hearings on the legislation, infuriating Democrats, who were frozen out of the drafting process.

To pass, Republicans must get at least 50 GOP senators to vote for the bill, since no Democrat or independent is expected to vote for it. Vice President Mike Pence would break any tie, and would be expected to vote for the bill. There are 52 Republican senators.

On Thursday, about an hour after the bill was posted online, NBC's Chuck Todd tweeted that a group of a conservative Republican senators were meeting, and that there are at least three GOP senators, and possibly more, who plan to announce later today that they will oppose the bill.

If that number proves to be accurate, it could be a death blow to the bill.

Sen. Rand Paul, R-Ky., told NBC that he and several other members of the GOP caucus would be making a statement on the bill later Thursday.

"It looks like we're keeping Obamacare, not repealing it," said Paul, who declined to say whether that meant he would vote against the bill.

Senate Majority Leader Mitch McConnell of Ky., center, followed by Majority Whip John Cornyn, R-Texas, leaves a Republican meeting on healthcare, Thursday, June 22, 2017, on Capitol Hill in Washington.
Jacquelyn Martin | AP

Senate Majority Leader Mitch McConnell, R-Ky., said Thursday, "There will be ample time to analyze" and discuss the bill before the legislation is put to a vote.

While McConnell praised the bill on the floor of the Senate, many of his Republican caucus members avoided speaking with reporters staking them out in Congress, who wanted to ask about the legislation.

Democrats promptly blasted the bill, and castigated Republicans for planning to call a vote on it just a week after its details were released.

"The Republicans want to give a tax break to the wealthiest Americans," said Senate Minority Leader Chuck Schumer, D-NY, on the floor of the Senate after release of the bill. "Simply put this bill will result in higher costs, less care, and millions of Americans will lose their health insurance."

"It's every bit as bad as the House bill. In many ways it's even worse," Schumer said. "The Senate bill is a wolf in sheep's clothing, but this wolf has even sharper teeth than the House bill."

House Speaker Paul Ryan, R-Wisc., during a press conference said, "From what I understand, their bill tracks along lines of House bill ... [I] think that's very good."

Leslie Dach, director of the Obamacare-supporting group Protect Our Care Campaign, tore into the Senate's bill, which, like Ryan, he compared to the House's earlier bill.

"Senate Republicans promised to start over and write a plan that improves people's health care," Dach said. "Instead they doubled down on the failed House repeal approach that puts everyone's health care last, and tax breaks for the wealthy first."

"The heartless Senate health care repeal bill makes health care worse for everyone — it raises costs, cuts coverage, weakens protections and cuts even more from Medicaid than the mean House bill," said Dach, who had served as senior counselor at the Department of Health and Human Services in the Obama administration.

GOP health bill has more to do with elimination of taxes
GOP health bill has more to do with elimination of taxes

"They wrote their plan in secret and are rushing forward with a vote next week because they know how much harm their bill does to millions of people."

But Seema Verma, administrator for the federal Centers for Medicare and Medicaid Services, praised the Senate's bill as she criticized Obamacare, a program that CMS oversees.

"I appreciate the work of the Senate as they continue to make progress fixing the crisis in health care that has resulted from Obamacare," Verma said. "Skyrocketing premiums, rising costs and fewer choices have caused too many Americans to drop their insurance coverage."

"Today, Obamacare is in a death spiral and millions ofAmericans are being negatively impacted as a result. They are trapped by mandates that force them to purchase insurance they don't want and can't afford," she said. "The Senate proposal is built on putting patients first and in charge of their health-care decisions, bringing down the cost of coverage and expanding choices. Congress must act now to achieve the President's goal to make sure all Americans have access to quality, affordable coverage."

The Congressional Budget Office said it expects to release an analysis of the bill early next week Monday. The analysis will estimate how many people are likely to become uninsured in the next decade if the bill becomes law, as well as how premiums for individual health plans would be affected.


The CBO "score" would also include projections on the bill's impact on federal spending.

The release of the draft comes more than six weeks after GOP leaders in the House barely managed to win passage for their own health-care legislation.

The House bill, the American Health Care Act, is widely unpopular, multiple polls have shown.

The nonpartisan CBO, in analyzing that bill, found that 23 million more Americans would become uninsured by 2026 if it became law than if Obamacare remained in place.

While many of those people would voluntarily cease buying insurance plans because of the elimination requirement that they have some form of health coverage or pay a fine, millions more would find their plans unaffordable because of either rising prices, the loss of government subsidies or both factors.

Watch: Rand Paul says new bill looks like Obamacare

Sen. Rand Paul: Senate health bill 'looks a lot like Obamacare'
Sen. Rand Paul: Senate health bill 'looks a lot like Obamacare'