After weeks of cloak and dagger discussions, Senate Republicans on Thursday released the text of their health care overhaul plan. The new bill would not upend Obamacare as abruptly as the House legislation, passed in May, but both call for significant cuts that would likely increase the ranks of the uninsured.
The CBO will score the bill over the weekend and Senate Majority Leader Mitch McConnell is planning for a vote late next week. If it passes, the House and Senate would need to hash out their differences and vote again on a compromise measure.
Here is a breakdown of how the Senate legislation stacks up to the House version — the American Health Care Act — and how both compare to Obamacare.
Note: This will be updated as we make our way through the text of the bill.
Obamacare greatly expanded Medicaid and mostly paid for it, allowing states that accepted the funding to provide coverage to millions of low-income Americans who couldn’t afford it before.
The Senate bill would could continue Medicaid expansion under Obamacare for three years, then begin to roll it back in 2021.
The overall program would also change. States would eventually receive a fixed amount — unlike the current open-ended funding requirement — in the form of a block grant or a figure based on the number of enrollees. In the Senate bill, that dollar amount would grow more slowly because, beginning in 2025, it would become tied to inflation, a less generous index than medical costs.
Obamacare guarantees coverage even for people with pre-existing conditions. The House bill would allow states to opt out of requiring those protections. The Senate bill does not, but — as explained below — insurers could provide skimpier coverage in states that get waivers for essential health benefits.
Obamacare required every health plan to cover certain essential benefits — everything from maternity and hospital care to prescription drugs and mental health. Both the Senate and House bill would allow states to redefine what qualifies as an “essential” element of a health care plan. Before Obamacare, insurers could sell coverage that didn’t cover things like mental health or prescription drugs. By stripping these insurance premiums would in certain cases becomes cheaper. But they would also provide fewer benefits.
Obamacare, in accordance with federal law, provides funding and reimbursements to the women’s health care provider, with the exception that none of that money can directly pay for or offset abortion services. Both the House and Senate bill would immediately cut off Planned Parenthood for at least one year.
Obamacare helped raise money for its expansion of health coverage by levying a new tax on the wealthy. Both the House and Senate bills eliminate Obamacare taxes on the wealthy and insurers.
Because it forced people to obtain health insurance or pay a penalty, Obamacare provided tax subsidies to help people — up to a certain income level — pay for it. The Senate bill is largely in line with Obamacare, tying subsidies for people paying for individual coverage to prices where they live and their income. The House legislation would only consider age.
Under Obamacare, nearly everyone had to either obtain health insurance or pay a penalty. That requirement would be fully reversed by the Senate bill. The House version also removed the mandate, but includes a provision that allows insurers to impose a 30% surcharge on individuals who allow their coverage to lapse, then want to sign on again. The effect is to use the threat of that one-time charge to encourage people to stay on their plans.
Obamacare helped young people get insured by allowing them to stay on their parents’ insurance until they were 26. Neither the House or Senate bill would remove that provision.
Most Americans actually get their health insurance through an employer and not through the government or health insurance exchanges. Both the House and Senate bill would strip the Obamacare provision requiring larger employers to provide affordable coverage.