Health and Science

GOP releases revised health-care bill in Senate, includes 'skimpy plans'; tough road remains for passage

Key Points
  • Republican leaders face opposition within their own caucus to ideas in the bill.
  • President Trump has said he will be "very angry" if he doesn't get an Obamacare replacement bill to sign.
  • An extra $70 billion in funding for states to help hold down insurance costs for customers has reportedly been added to the revised bill.
GOP releases revised health-care bill in Senate, includes 'skimpy plans;' tough road remains for passage

The revised Republican bill to replace Obamacare was revealed Thursday by Senate leaders, and allows the sale of less-generous insurance plans, retains significant planned cuts to Medicaid, keeps some Obamacare taxes on the wealthy and offers larger subsidies to help people buy health plans than the old version did.

But the new version of the Senate bill, as with the first, faces a difficult route to passage because of concerns about its effects among some GOP caucus members.

However, Sen. John Cornyn of Texas, the second-ranking Republican in the Senate, said there will be enough votes to pass the revised bill by the time it comes to a vote.

A vote on a motion to proceed with the bill is expected to be held next week. That would allow amendments to be offered for the bill, and put it on track to a final vote.

The revised legislation will add another $70 billion in federal funding on top of an already-proposed $112 billion earmarked for states to help reduce insurance premiums and out-of-pocket costs for customers in the individual plan markets. The bill also calls for allowing people, for the first time, to use their health savings accounts to pay for their premiums.

The bill also would allow the sale of health plans that do not comply with current minimum standards set by Obamacare, and for federal tax credits to help customers pay for such skimpy plans. The Affordable Care Act, as of now, bars insurers from charging sicker customers higher premiums, and also mandates that insurance plans contain a minimum set of "essential health benefits" for customers.

The bill's new provision would allow insurers to sell less-expensive plans, which at the same time offered fewer coverage benefits.

A leading health insurance lobbying group has strongly criticized that idea, saying it would lead to higher premiums for sick people, who would not be interested in buying less coverage than they need.

GOP senators to unveil revised health-care bill

The bill will retain significant cuts to spending on Medicaid, the government-run health coverage program for the poor. That is certain to be met with dismay by a number of moderate Republicans who opposed the first version of the bill for that reason.

The revised legislation will retain a set of Obamacare taxes, including a 3.8 percent surcharge on high-income earners.

The bill also would add an additional $45 billion toward tackling the opioid abuse epidemic, with that funding earmarked for substance abuse treatment and recovery.

There are just 52 Republican senators, which means that GOP leaders can afford to have just two members of their party's caucus oppose the bill if they hope to pass it. Vice President Mike Pence would break any tie in the favor of his fellow Republicans.

But at least eight GOP senators opposed the original version of the Senate bill.

Sen. Lindsey Graham, R-S.C., told reporters that the new bill was "well-received" by GOP senators when they heard about it from Majority Leader Mitch McConnell, R-Ky. in a meeting Thursday.

McConnell spoke on the Senate floor after that meeting.

He said that Americans were losing choices in their insurance plans under Obamacare, saying the current health-care law is headed toward "total meltdown."

McConnell said the Republican bill was made "stronger" in recent weeks with its revisions.

The new version was crafted after Senate GOP leaders, stung by an unfavorable analysis of the original bill, postponed a planned vote on that earlier version until after the July Fourth congressional recess.

The new version will be analyzed by the nonpartisan Congressional Budget Office.

The CBO's "score" of the revised bill, which is expected to be released early next week, will estimate how many more Americans would lack health insurance if the bill is signed into law, and also would project how insurance plan premiums would be affected.

In its analysis of the first version of the bill, the CBO estimated that it "would increase the number of people who are uninsured by 22 million in 2026 relative to the number under current [Affordable Care Act] law." That was only 1 million fewer than what the CBO had estimated a House bill would lead to.

"By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law," the CBO said it its report on the earlier bill, released June 26.

It is by no means clear that the new CBO score will show significantly fewer people becoming uninsured under the new version of the bill than under the original draft of it.

A sign of the difficulties faced by GOP leaders came Wednesday from Sen. Rand Paul, R-Ky, who told reporters that day, before seeing the new version, that, "As far as I can tell, the new bill is the same old bill."

"I can't support it," he said.

Paul, like other more-conservative members of the GOP caucus, wants a bill that is more aggressive in repealing key elements of Obamacare.

In addition to Paul, moderate GOP senators like Dean Heller of Nevada and Susan Collins of Maine opposed the original Senate bill.

However, President Donald Trump on Wednesday told the Christian Broadcasting Network that he will be "very angry" if Congress does not send him a bill to replace Obamacare.

"I'm sitting waiting for that bill to come to my desk," Trump said. I hope that they do it. They've been promising it for years."

Craig Garthwaite, co-director of the Health Enterprise Management Program a Northwestern University's Kellogg School of Management, told CNBC that "broadly speaking, the legislation has some interesting new elements."

"Being able to pay premiums with pre-tax dollars is a good improvement, as is the change" funding to funding for hospital that serve a large number of Medicaid and uninsured individuals," Garthwaite said.

"That being said, without changes in the subsidy structure or in the Medicaid program the bill still amounts to a fundamental cut in access for low-income enrollees," Garthwaite said. "In addition, the attempt to create a set of non-compliant [health] plans invites adverse selection in a way that would be damaging, rather than stabilizing, to the individual market."

Adverse selection refers to the phenomenon when a disproportionate number of people with health problems enroll in an insurance plan, causing the plan to raise its premiums, which in turn discourages health customers from enrolling.

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