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| Senate Republicans release healthcare bill that will affect coverage for millions | Senate Republicans release healthcare bill that will affect coverage for millions |
| (35 minutes later) | |
| After weeks of secret negotiations, the US Senate has released an anticipated draft of a bill that could upend the healthcare system for millions of Americans. | After weeks of secret negotiations, the US Senate has released an anticipated draft of a bill that could upend the healthcare system for millions of Americans. |
| The Senate’s 142-page proposal unveiled Thursday would eliminate or reduce key benefits provided by the Affordable Care Act, lower taxes for the wealthy, strip funding from the women’s reproductive health provider Planned Parenthood and dramatically cut and restructure Medicaid, America’s public health insurance program for low-income and disabled Americans. | The Senate’s 142-page proposal unveiled Thursday would eliminate or reduce key benefits provided by the Affordable Care Act, lower taxes for the wealthy, strip funding from the women’s reproductive health provider Planned Parenthood and dramatically cut and restructure Medicaid, America’s public health insurance program for low-income and disabled Americans. |
| The legislation mirrors the House bill that narrowly passed last month, with modest changes intended to win support from moderate Senators. Meanwhile, Republican leaders emphasize the legislation is subject to change as they negotiate details in an effort to win 50 votes, the minimum required to pass. | The legislation mirrors the House bill that narrowly passed last month, with modest changes intended to win support from moderate Senators. Meanwhile, Republican leaders emphasize the legislation is subject to change as they negotiate details in an effort to win 50 votes, the minimum required to pass. |
| Donald Trump said he thought the final legislation would be “very good” with “a little negotiation”. He added: “Obamacare is dead and we’re putting a plan out today that is going to be negotiated. We’d love to have some Democrats’ support but they’re obstructionists.” | Donald Trump said he thought the final legislation would be “very good” with “a little negotiation”. He added: “Obamacare is dead and we’re putting a plan out today that is going to be negotiated. We’d love to have some Democrats’ support but they’re obstructionists.” |
| On Wednesday night he called on Republicans to improve the plan by giving it more “heart”. | On Wednesday night he called on Republicans to improve the plan by giving it more “heart”. |
| Senate Republicans heard about the substance of the healthcare reform effort for the first time Thursday morning, just days before leadership intends to hold a vote. | Senate Republicans heard about the substance of the healthcare reform effort for the first time Thursday morning, just days before leadership intends to hold a vote. |
| Experts believe the bill could leave millions of Americans without health insurance, and could have a stark impact on vulnerable populations such as recovering drug addicts, aging middle-class baby boomers and women and children. | Experts believe the bill could leave millions of Americans without health insurance, and could have a stark impact on vulnerable populations such as recovering drug addicts, aging middle-class baby boomers and women and children. |
| That impacts are likely to prompt questions about how senators can sell voters on a bill that left the House with a 17% public approval rating, and the expectation that 23 million Americans will lose health insurance. | That impacts are likely to prompt questions about how senators can sell voters on a bill that left the House with a 17% public approval rating, and the expectation that 23 million Americans will lose health insurance. |
| Senators want to give the middle-class tax credits to buy insurance, but those subsidies would still be worth less than those currently provided by the Affordable Care Act, better known as Obamacare. People would also need to earn less money to quality for them. | Senators want to give the middle-class tax credits to buy insurance, but those subsidies would still be worth less than those currently provided by the Affordable Care Act, better known as Obamacare. People would also need to earn less money to quality for them. |
| Additionally, the Senate’s bill would still allow states to decide which benefits insurance must cover. This could herald a return to pre-Obamacare days, when Americans who bought their own insurance faced expensive riders for coverage such as mental health care, and maternity care of addiction treatment. Any changes to which benefits insurance must cover is expected to have an outsized impact on people with pre-existing conditions. | |
| The bill would also slash Medicaid, a program that pays for half of all births in the United States and provides health insurance to one in five Americans. If passed, changes in the Senate bill would be some of the most significant health reforms for low-income Americans in more than 50 years. | The bill would also slash Medicaid, a program that pays for half of all births in the United States and provides health insurance to one in five Americans. If passed, changes in the Senate bill would be some of the most significant health reforms for low-income Americans in more than 50 years. |
| The bill would change Medicaid in two ways. First, it would phase out payments to states that expanded Medicaid under Obamacare between 2020 and 2023, a major cut to the program. | The bill would change Medicaid in two ways. First, it would phase out payments to states that expanded Medicaid under Obamacare between 2020 and 2023, a major cut to the program. |
| Then, the bill would change Medicaid from a program that matches states’ contributions, no matter the spending, to one with a capped budget called “per capita” spending. | Then, the bill would change Medicaid from a program that matches states’ contributions, no matter the spending, to one with a capped budget called “per capita” spending. |
| The House bill would have cut more than $800bn from the program. Those levels of cuts were expected to result in 14 million people being pushed from the program. As states look for ways to save money, they could be pushed to cap levels of spending on individual recipients, impacting costly beneficiaries like the elderly and disabled. | The House bill would have cut more than $800bn from the program. Those levels of cuts were expected to result in 14 million people being pushed from the program. As states look for ways to save money, they could be pushed to cap levels of spending on individual recipients, impacting costly beneficiaries like the elderly and disabled. |
| Some especially vulnerable populations could also see major changes to their healthcare. An estimated 220,000 recovering drug addicts depend on Medicaid for drug treatment, an analysis by the left-leaning Center for Budget and Policy Priorities found. That could worsen America’s ongoing opioid overdose crisis, which killed more than 50,000 Americans in 2016. | Some especially vulnerable populations could also see major changes to their healthcare. An estimated 220,000 recovering drug addicts depend on Medicaid for drug treatment, an analysis by the left-leaning Center for Budget and Policy Priorities found. That could worsen America’s ongoing opioid overdose crisis, which killed more than 50,000 Americans in 2016. |
| The bill would also prohibit Planned Parenthood from participating in Medicaid for one year, forcing hundreds of thousands of women to find a new source of reproductive health care. | The bill would also prohibit Planned Parenthood from participating in Medicaid for one year, forcing hundreds of thousands of women to find a new source of reproductive health care. |
| Each year, about 1.6 million patients, mostly women, receive sexually transmitted infection tests, contraception and cancer screenings at Planned Parenthood through federal programs like Medicaid. Planned Parenthood, in return, receives roughly half a billion dollars annually in federal Medicaid reimbursements. | Each year, about 1.6 million patients, mostly women, receive sexually transmitted infection tests, contraception and cancer screenings at Planned Parenthood through federal programs like Medicaid. Planned Parenthood, in return, receives roughly half a billion dollars annually in federal Medicaid reimbursements. |
| Republicans, though, object to funneling so much federal money to a major abortion provider. | Republicans, though, object to funneling so much federal money to a major abortion provider. |
| The bill would also bar federal tax credits from paying for commercial insurance plans that provide abortion coverage. That provision could be especially problematic in states such as New York and California, where insurance plans are required to sell such coverage. | The bill would also bar federal tax credits from paying for commercial insurance plans that provide abortion coverage. That provision could be especially problematic in states such as New York and California, where insurance plans are required to sell such coverage. |
| The loss of Medicaid funds would force Planned Parenthood – which is the largest family planning provider in scores of counties – to close an untold number of clinics. Republicans have argued that other community health care providers could pick up Planned Parenthood’s caseload. But public health experts are extremely skeptical or dismissive of this claim. | The loss of Medicaid funds would force Planned Parenthood – which is the largest family planning provider in scores of counties – to close an untold number of clinics. Republicans have argued that other community health care providers could pick up Planned Parenthood’s caseload. But public health experts are extremely skeptical or dismissive of this claim. |
| The provision to defund Planned Parenthood, however, may violate the rules for budget reconciliation legislation, and Republicans could be forced to scrap it. | The provision to defund Planned Parenthood, however, may violate the rules for budget reconciliation legislation, and Republicans could be forced to scrap it. |
| At the same time, the bill would repeal a number of taxes on the wealthy and on the healthcare industry. The bill also allows people to save more for health expenses in tax-advantaged savings accounts, a change also expected to benefit the wealthy. | At the same time, the bill would repeal a number of taxes on the wealthy and on the healthcare industry. The bill also allows people to save more for health expenses in tax-advantaged savings accounts, a change also expected to benefit the wealthy. |
| All told, the healthcare sector accounts for roughly one-sixth of the US economy. Approximately 20 million people gained insurance under Obamacare. | All told, the healthcare sector accounts for roughly one-sixth of the US economy. Approximately 20 million people gained insurance under Obamacare. |
| Almost half of Americans, about 155 million people or 49% according to the Kaiser Family Foundation, get health insurance through an employer. The next two largest groups are the poor and the elderly, who use the public health insurance programs Medicaid and Medicare, and represent about 34% of the population together. | Almost half of Americans, about 155 million people or 49% according to the Kaiser Family Foundation, get health insurance through an employer. The next two largest groups are the poor and the elderly, who use the public health insurance programs Medicaid and Medicare, and represent about 34% of the population together. |
| Another group of people buy insurance on the “individual” market. This group makes up about 9% of the country who buy insurance through marketplaces set up by Obamacare. | Another group of people buy insurance on the “individual” market. This group makes up about 9% of the country who buy insurance through marketplaces set up by Obamacare. |
| The bill was negotiated behind closed doors between 13 Republican male senators representing 10 states – eight of which did not expand Medicaid. Senate majority leader Mitch McConnell has said he would like to vote on the healthcare bill before Congress leaves for the Fourth of July recess, at the end of next week. | |
| In a floor speech on Thursday, McConnell said the bill incorporated input from “many members” and promised that there would “ample time to analyze, discuss and provide thoughts” before the bill is brought to the floor for a vote. He said a cost and impact analysis from the Congressional Budget Office (CBO) would likely be completed by early next week. | |
| “After that, we will proceed with a robust debate and an open amendment process on the Senate floor – a process that I would encourage each of our 100 senators to participate in,” McConnell said. | |
| Following McConnell to the floor, Schumer said the legislation may be “meaner” than the version passed by the House last month. | |
| “The Senate Republican healthcare bill is a wolf in sheep’s clothing, only this wolf has even sharper teeth than the House bill,” he said. | |
| Democrats vowed to continue their protest on Thursday, disrupting routine order in the Senate to draw attention to their demand that Republicans hold a public hearing on the legislation. | |
| Republicans can only afford to lose two GOP senators if they are to get the bill through the Senate. They are using a special budget process called reconciliation that allows them to bypass a Democratic filibuster. | Republicans can only afford to lose two GOP senators if they are to get the bill through the Senate. They are using a special budget process called reconciliation that allows them to bypass a Democratic filibuster. |
| Republicans will spend the next several days playing with the details in a rush to assemble a bill that will pass the Senate. But after the briefing on Thursday, Republican senators could offer little assurances, admitting that it is still a draft that is certain to undergo numerous informal and formal changes. | |
| Senator Bob Corker of Tennessee said: “It’s truly a draft ... I’m not that superficial to say I support or don’t support a bill I haven’t read.” | |
| Senator Lindsey Graham of South Carolina added: “I think we’re probably going to get a lot of pushback from people from the right in the House.” | |
| Conservative Utah senator Mike Lee is concerned that the bill does not go far enough to repeal the Affordable Care Act. But moderates, such as Susan Collins of Maine and Lisa Murkowski of Alaska, want a slower phase-out of Medicaid expansion, because of its potential impact on low-income residents in their states. |