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Senate Majority Leader Mitch McConnell, a Republican from Kentucky, speaks during a news conference April 4 after a Senate Republican luncheon at the U.S. Capitol in Washington, D.C. Democrats are threatening to block Neil Gorsuch's nomination to the Supreme Court. Republicans say they have the votes to change the Senate's longstanding rules and push President Donald Trump's nominee through. Photo by Aaron P. Bernstein/Bloomberg via Getty Images

What’s in the Senate Republican health care bill

It’s part Obamacare-replace, part sweeping-Medicaid-overhaul. At roughly 10:45 am this morning, Senate Republican leaders posted their 142-page health care proposal. (Read the full bill here).

It is, notably, a “draft” bill, meaning that now Republicans will negotiate among themselves before an expected vote next week. “We’re going to make a lot of changes over the next seven days,” South Carolina Senator Tim Scott told reporters.

But this is the key starting point. Here is our initial look at what the Senate bill proposes:

Medicaid

  • 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.

Pre-existing conditions

  • 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.

Essential benefits

  • States could allow insurers to totally remove or alter what must be included in basic insurance coverage, using the 1332 waivers mentioned above. Under the Affordable Care Act, 10 types of medical services — from hospitalization to preventive care — are required as part of all insurance plans.

Planned Parenthood

  • 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.

Opioids

  • The plan marks $2 billion in funding for fighting opioid addiction and helping states with treatment and response.

What’s next?

  • The bill will go to the Senate for debate next week.
  • The Congressional Budget Office says it aims to have cost estimates for the bill out “early next week.”
  • Republican leaders plan to allow 20 hours for debate: 10 hours for Democrats and 10 for Republicans.
  • Both parties will be able to propose amendments to the bill, a process expected to lead to a long “vote-a-rama” session of up-and-down amendment votes in the Senate.

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