ObamaCare: Six key parts of the Senate bill
While Senate Republicans are drafting their healthcare plan behind closed doors, they’ve given reporters a general idea of what might be in it.
The bill is shaping up to have a similar structure as the House’s bill, while more reflecting the principles of centrist Republicans in both chambers.
Senators are still hashing out the specifics, but here’s a look at where they appear to be headed.
It will slow down the phase-out of the Medicaid expansion
Senators from states that expanded Medicaid under ObamaCare don’t want to see federal funds quickly dry up, as would happen under the House ObamaCare repeal bill.
Sen. Rob Portman (R-Ohio) has proposed a seven-year phase-down in the funding, a timeframe backed by other centrists including Sen. Dean Heller (Nev.), probably the most vulnerable Senate Republican in next year’s election.
Senate Majority Leader Mitch McConnell (R-Ky.) has proposed a three-year phase-down.
A final bill might have something in between.
“My hope is that a longer glide path with flexibility will give the states and the governors the ability to extend the coverage to the population,” Sen. Shelley Moore Capito (W.Va.), another key GOP vote, told reporters this week.
Tax credits will be beefed up
Sen. John Thune (R-S.D.) has been working on a tax credit structure that would gear more tax credit help to pay for insurance toward people with low incomes and older Americans.
Thune told reporters this week he has sent different options of the structure to the Congressional Budget Office to be evaluated.
The tax credits in the House bill ranged from $2,000 to $4,000 and were based on age, not income. Those credits would phase out for individuals with an annual income of $75,000 and end completely for those making $95,000 or more.
Thune’s credits will cut off eligibility sooner for people with higher incomes and make credits larger, tying them to age and income while giving older people more support.
It will keep some ObamaCare taxes
If Senate Republicans want to spend more on health insurance subsidies and slow down the phase-out of the Medicaid expansion to win over more moderate votes, they need to find a way to pay for it.
There’s been a general consensus that some ObamaCare taxes will need to stay, at least for the short term.
“Certainly there’s an agreement that you eliminate every tax that has to do with increasing the costs of insurance premiums — so the health insurance tax, the medical device tax, the prescription drug tax — there is some question about what you do with the taxes related to high income individuals, and that’s part of the debate,” Sen. John Barrasso (Wyo.), who is a member of leadership, told reporters Thursday.
The House bill retroactively repealed nearly all of ObamaCare’s taxes to the start of 2017, but delayed the repeal of the Medicare surtax on high earners until 2023 and the implementation of the tax on high-cost health plans until 2026.
It will include more funding to combat the opioid crisis
To appease senators worried about curtailing the Medicaid expansion, which plays a major role in providing coverage for addiction treatment, more money is coming for the opioid crisis.
But it’s unclear how much.
“In addition to my efforts to give governors more time and flexibility to adjust to a new system, I’m working with my colleagues to provide governors with a dedicated new funding stream to ensure those using expanded Medicaid resources to treat their addiction can continue to receive treatment as they work to get back on their feet,” Portman said in a statement to the Columbus Dispatch this week.
It will try to stabilize the ObamaCare exchanges
Insurers across the country have proposed big rate increases for 2018, and others are leaving the market altogether.
While Republicans want to repeal ObamaCare, they also need to make sure the markets remain relatively stable.
This could include funding for a few years for ObamaCare’s cost-sharing reduction payments, which reimburse insurers for giving discounts to low-income customers.
The Trump administration hasn’t provided clarity on how long the payments will continue, leading insurers to hike premiums to compensate for the possible loss of funding.
The House-passed American Health Care Act (AHCA) funded the payments through 2020, and the Senate bill will likely do the same.
“The payments will help to avoid the real possibility that millions of Americans will literally have zero options for insurance in the individual market in 2018,” Sen. Lamar Alexander (R-Tenn.) said at a hearing Thursday.
Alexander has also proposed a bill that would allow people who live in counties with no insurers on the exchanges to use their subsidies for other health plans. That language could be included in the Senate’s health bill.
It will include more funding to handle preexisting conditions
Sen. Susan Collins (R-Maine) told reporters Thursday that the House bill “grossly underfunds” high-risk pools to help people with pre-existing conditions, and that it would need at least $15 billion in its first year to work.
The AHCA dedicated $15 billion over nine years for states to create their pools, on top of a last-minute amendment that would give $8 billion over five years to a fund to help with premiums and cost-sharing for people with pre-existing conditions. That works out to about $3.3 billion per year.
There’s also a $100 billion pool of money in the House bill to help states stabilize their insurance markets, which can be used to help people with pre-existing conditions as well as other purposes, but senators may want a dedicated source of funding specifically for the pools.
“We need to focus on getting people with pre-existing conditions [covered] while also lowering premiums,” Barrasso told reporters Thursday.
“One of the ways you can do that is with something like the Maine high risk pool, that Susan Collins has been a strong advocate for. The issue in our discussion is you have to make sure there’s enough money in it … There’s some concern that the house bill, which is in the right direction, doesn’t adequately fund the high risk pool the level you would need it to be at to bring down the premium levels because 5 percent of the patients is about 55 percent of the spending.”
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