- The Senate version of the American Health Care Act (AHCA) was revealed Thursday. It, like the House version, makes drastic cuts to Medicaid and fundamentally changes the program. It also allows states to circumvent essential health benefit requirements and rolls back key ACA regulations.
- Senate Majority Leader Mitch McConnell (R-Ky.) is sticking by his intention for senators to vote on the bill before they leave for the July 4 break, but the timeline is tight and there is still no score from the Congressional Budget Office (CBO).
- The Senate bill has key differences from the House bill, including a delay on the phasing out of Medicaid expansion, a stricter cap to Medicaid funding and attempts to protect people with pre-existing conditions. It would also calculate premium subsidies based on income and age, rather than just on age.
This version of the bill is quite likely to change before it goes to a vote. The bill’s drafters are scrambling to get support from the more conservative and moderate wings of the party without alienating the other. Four far-right Republicans said Thursday afternoon they won't support the bill as is, but are open to negotiation.
The House passed its version of the bill last month. The CBO estimated that bill would likely result in 23 million people losing coverage. The majority of that stems from phasing out Medicaid expansion.
Democrats, advocates and even some Republicans have been critical of the Senate bill’s development, which has occurred entirely behind closed doors. In the past day or so some details of the bill have leaked, and there are concessions for both.
Like the House version, the Senate bill would phase out Medicaid expansion, but would delay it until 2020 and the transition would last four years. The bill would also restrict the growth of Medicaid funding more severely by tying it to inflation instead of medical inflation plus one percentage point. Diane Rowland, executive vice president of the Kaiser Family Foundation, posted on Twitter that such a restriction would mean cuts in care for people who are poor or disabled as well as less funding for safety net hospitals.
The Senate bill also has a provision that would decrease the number of people who qualify for premium subsidies by changing the income level from 400% to 350% of the poverty level. This would lower premium costs for younger people but increase them for older people. Both versions of the bill defund Planned Parenthood and repeal the ACA's taxes. The Senate bill brings back the Cadillac tax on high-end employer health plans in 2026.
The American Hospital Association (AHA), American Medical Association and other major industry groups have said they oppose the AHCA because of the millions who would lose coverage with its implementation. AHA President Rick Pollack said in a statement: "Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance. We urge the Senate to go back to the drawing board and develop legislation that continues to provide coverage to all Americans who currently have it."