WASHINGTON — The Senate Republican health care bill to be made public Thursday would roll back taxes, phase down Medicaid expansion, rejigger subsidies and end federal funding for Planned Parenthood, according to a draft of the measure.
The bill, which Republicans worked on in secret for the past several weeks, largely mirrors the House measure that passed in May but has some significant changes, according to a draft circulated Wednesday afternoon that The Washington Post obtained.
Senate Majority Leader Mitch McConnell (R-Ky.) will brief the Senate Republican Conference Thursday morning on what he called “a discussion draft” as he pushes for a vote to replace the current health care legislation, known as Obamacare, before Congress leaves for the July Fourth recess next week.
The proposal, which aides said still could change, would link federal subsidies to help individuals pay for insurance to income rather than to age, as the House bill does. It would end Medicaid expansion more gradually than the House version but has deeper long-term cuts, the Post reported.
It also would remove restrictions on federally subsidized health plans from covering abortions, to meet requirements of a budgetary procedure that allows the bill to pass with just 51 votes.
“We believe we can do better than the Obamacare status quo, and we fully intend to do so,” McConnell said on the Senate floor Wednesday.
Senate Minority Leader Chuck Schumer (D-N.Y.) vowed a fight in a conversation with “Pod Save America,” a podcast run by four of former president Barack Obama’s aides.
“Our whole focus, if McConnell will bring this up right before July 4, is to get three votes against the motion to proceed, and we think we have a damn good chance,” Schumer said. “This is full-scale warfare. We’re not going to be complacent or go along with business as usual.”
McConnell acknowledged Democrats will vote against the legislation, but he also faces differences within his own party over measures in the bill that could erode his 52-vote majority.
Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska), from the GOP’s moderate wing, and conservative Sens. Mike Lee (R-Utah) and Rand Paul (R-Ky.) have expressed concern about the secret process and the potential shape of the final legislation.
Sen. Ron Johnson (R-Wis.), part of the working group on the bill, said, “It’s very complex. I think within two meetings I saw the wide spectrum of opinions within the Republican conference trying to fix this mess of Obamacare.”
The bill’s changes to Medicaid could be aimed at winning over specific senators, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation, a nonpartisan group analyzing health care issues.
Some Republicans from states that expanded Medicaid to include more working low-income people under Obamacare — such as Sen. Shelley Moore Capito (R-W. Va.) and Sen. Rob Portman (R-Ohio) — said they wanted Medicaid reductions to be gradual.
Complicating the issue is the key role of Medicaid expansion in funding treatment of opioid and substance abuse. According to The Associated Press, Medicaid expansion accounted for 61 percent of total Medicaid spending on substance abuse treatment in Kentucky, 47 percent in West Virginia, 56 percent in Michigan and 59 percent in Maryland.
After President Donald Trump reportedly called the House bill “mean,” Pollitz said, “There seems to be an effort to make the bill less ‘mean,’ so that could mean slowing or ramping back a little bit of the phaseout of the expansion money.”
The draft version the Post obtained sets subsidies for people earning up to 400 percent of the poverty level, but that threshold would lower in 2020 to 350 percent. The draft would also tie federal Medicaid spending in 2025 to a slower growth index than the House bill.
The draft also proposes repealing all of the Affordable Care Act taxes except for its so-called “Cadillac tax” on high-cost health plans, according to the news report.