The Senate Republicans have their Obamacare replacement out. Here’s what made the cut.
- Funding for Medicaid would be capped and reduced. The amount of funding cut is not yet clear – it is based on a new approach to Medicaid. Now Medicaid’s funds all needs of patients. Starting in 2020, under the Senate bill, states must choose between accepting one large, capped, block grant or accepting a predetermined amount of funding per recipient.
- Medicaid expansion would phase out between 2020 and 2023(to 75 percent funding in 2023), and end by 2024. According to the Kaiser Family Foundation, that expansion brought health coverage to some 14 million people.
- States could add a work requirement for able-bodied (non-elderly, non-disabled, non-pregnant) recipients of Medicaid.
Subsidies to individuals to help buy coverage
- Affordable Care Act tax credits would remain, initially, but go to fewer people. This would keep the ACA tax subsidy structure for individuals who can’t afford health insurance, but it would limit who would qualify to those making 350 percent of poverty. It is currently 400 percent of poverty.
- Expand who can get subsidies. The bill would give states more flexibility to use a kind of waiver known as “1332”. That would allow them to provide subsidies not just for people in the exchanges, but for others struggling to afford insurance.
$110 billion in other help for coverage
- $50 billion would go to states for the next four years to help them reduce premiums for individuals.
- $62 billion would go to a “Long-term Stability Fund” to additionally help states handle gaps in coverage. That money would be funded over 10 years, with larger amounts during the first few years.
- Affordable Care Act protections for those with pre-existing conditions would stay in place, meaning insurers could not charge more for people with previous health issues. (This is known as the “community rating”.) Here the Senate is breaking with the House health care bill, which allows states to remove those protections and give insurers more pricing flexibility if they choose.
- All federal funding for the women’s health organization would be cut as long as it continues to offer abortion services. Currently no federal funding can support abortion procedures, but Planned Parenthood receives grants for other services, including screenings and access to contraception.
What taxes are repealed
- Nearly all Affordable Care Act taxes and fees would be repealed.
- The so-called “Cadillac Tax” on generous employer health care plans would be repealed, but only through 2025.
$2 billion in funding would go to fight opioid addiction and help states with treatment and response.
The bill is a partial repeal of Obamacare. It caps and gets rid of Medicaid expansion, eventually. It also changes the tax credit structure.
Is this bill a better bill than Obamacare? We’ll leave it to the reader to judge.