Senate Republican leaders on Thursday morning released a draft of their ObamaCare repeal-and-replace bill; now the quest to secure 51 votes begins.

It won’t be an easy task, and it’s likely some of the details will have to be tweaked to win over conservative or centrist members.

Here’s what’s in the bill:

A longer phaseout of the Medicaid expansion. The House bill ended extra federal funds for Medicaid expansion in 2020. But the Senate bill begins phasing out these enhanced funds starting in 2021 and restoring it to pre-Affordable Care Act levels by 2024. Moderates have been seeking a seven-year transition.

{mosads}• Deeper cuts to Medicaid. The Senate bill cuts deeper than the House’s starting in 2025. At that time, the cap on Medicaid payments would grow at a slower rate, known as CPI-U. 

Defunding of Planned Parenthood for one year. Ending federal funding for the organization could be an issue for Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine).

 • An additional $2 billion in fiscal 2018 for states to address the opioid crisis. Sens. Shelley Moore Capito (R-W.Va.) and Rob Portman (R-Ohio) have been pushing for an additional $45 billion over 10 years.   

• Cuts to ObamaCare tax credits. The House bill factored in age, but not income, when determining how much financial assistance to help people afford their premiums. But the Senate keeps the ObamaCare structure in place, factoring in age, income and geography. 

• The elimination of the individual and employer mandates for having and providing insurance. 

• Funding to continue cost-sharing reduction payments through 2019. Insurers have been pleading for certainty with the ObamaCare payments, which decrease out-of-pocket costs for some low-income consumers.

• More flexibility on insurance regulations. The bill doesn’t include the controversial House waivers letting states charge consumers more based on health status and lifting a requirement to cover certain health services. But it bolsters waivers created under the Affordable Care Act that gives states use creative ways to implement ObamaCare. The new powers give the states more flexibility to use waivers to decide the rules of insurance for their state. 

Senior GOP Senate aides say the waivers can be used to waive essential health benefits. But in a departure from the House bill, states can’t opt of regulations governing pre-existing conditions. 

• Changes the age rating to 5:1. That means insurers can charge older adults five times as much as younger people. ObamaCare only lets insurers charge older people three times as much.

• No tax credits for plans that cover abortion. But there’s been talk that this provision might not fit within the parameters of reconciliation, the fast-track budget maneuver the GOP is using to repeal and replace ObamaCare with a simple majority.

Repeals all of ObamaCare’s taxes. The only tax kept is the Cadillac tax, a fee levied on pricey employer insurance plans, though it would be delayed until 2026. 

– This story was updated at 1:04 p.m.

Tags Lisa Murkowski Rob Portman Shelley Moore Capito Susan Collins

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