Republicans unveil bill to replace Obamacare, change Medicaid

Senate Republicans released their long-awaited bill Thursday to dismantle much of Barack Obama's health-care law, proposing to cut Medicaid for low-income Americans and erase tax boosts that Obama imposed on high-earners and medical companies to finance his expansion of coverage.

The bill would provide tax credits to help people buy insurance. It would also let states get waivers to ignore some coverage standards that the Affordable Care Act, or "Obamacare," requires of insurers. And it would end the tax penalties under Obama's law on people who don't buy insurance the so-called individual mandate and on larger companies that don't offer coverage to their employees.

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Obamadenounced the Senate bill in a Facebook post, arguing, "It would raise costs, reduce coverage, roll back protections, and ruin Medicaid as we know it."

The measure represents the Senate Republicans' effort to achieve a top-tier priority for President Donald Trump and virtually all Republican members of Congress. Mitch McConnell, Republican majority leader of the Senate from Kentucky, hopes to push it through his chamber next week.

"We have to act," McConnell said on the Senate floor. "Because Obamacare is a direct attack on the middle class, and American families deserve better than its failing status quo."

Trump tweeted that he is "very supportive of the Senate#HealthcareBill."

4 conservative senators opposed

But some Republican senators, as well as all the Senate's Democrats, have complained about McConnell's proposal, the secrecy with which he drafted it and the speed with which he'd like to whisk it to passage. McConnell has only a thin margin of error: The bill will fail if just three of the Senate's 52 Republicans senators join the Democratsinopposingit.

Kentucky Senator Rand Paul said he was among a group of four Republicans who are strongly in favour of limited government who couldn't support the current iteration of the bill, with the others being Ted Cruz of Texas, Mike Lee of Utah and Ron Johnson of Texas.

Paul called the bill "Obamacare light" and said the timeline to vote on it "seems like a short time."

Several protesters, some in wheelchairs, gathered outside of McConnell's office. Capitol Hill police could be seen carrying protesters out and trying to maintain order. Forty-three demonstrators were arrested, according to a police news release.

'Wolf in sheep's clothing'

Democrats gathered on the Senate floor and defended Obama's 2010 overhaul. They said characterizations of the law as failing are wrong and said the Republican plan would boot millions off coverage and leave others facing higher out-of-pocket costs.

Democratic minority leader Chuck Schumer derided the bill, and the process surrounding it, as no committee hearings are planned before the vote. Schumer called it a "wolf in sheep's clothing."

"We live in the wealthiest country on Earth. Surely we can do better than what the Republican health-care bill promises," said Schumer.

Obama, in his Facebook post, describes the bill as, "a massive transfer of wealth from middle-class and poor families to the richest people in America. It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else."

Some conservative and moderate Republican senators have their doubts, too.

Dean Heller, facing a tough re-election fight next year, said he had "serious concerns' about the bill's Medicaid reductions.

"If the bill is good for Nevada, I'll vote for it and if it's not, I won't," said Heller, a Republican, whose state added 200,000 additional people under Obama's law.

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The House approved its version of the bill last month. Though he lauded its passage in a Rose Garden ceremony, Trump last week privately called the House measure "mean" and called on senators to make their version more "generous."

At the White House on Thursday, Trump expressed hope for quick action.

"We'll hopefully get something done, and it will be something with heart and very meaningful," he said.

The bill would phase out the extra money Obama's law provides to states that have expanded coverage under the federal-state Medicaid program for low-income people. The additional funds would continue through 2020, and be gradually reduced until they are entirely eliminated in 2024.

Ending the Obamacare expansion has been a major problem for some Republican senators. Some from states that have expanded the program have battled to prolong the phase-out, while conservative Republicans have sought to halt the funds quickly.

Money earmarked to shore up markets

Beginning in 2020, the Senate measure would also limit the federal funds states get each year for Medicaid. The program currently gives states all the money needed to cover eligible recipients and procedures.

The Senate bill would also reduce subsidies now provided to help people without workplace coverage get private health insurance, said Caroline Pearson, a senior vice-president of the health-care consulting firm Avalare Health.

While the House billbases its subsidies for private insurance on age, the Senate bill uses age and income. That focuses financial assistance on people with lower incomes.

Pearson said those subsidies will be smaller than under current law. That's because they're keyed to the cost of a bare-bones plan, and because additional help now provided for deductibles and co-payments would be discontinued.

Under Obama's law, "many of those people would have gotten much more generous plans," she said.

Blocks payments to Planned Parenthood

The bill would let states get waivers to ignore some coverage requirements under Obama's law, such as specific health services insurers must now cover. States could not get exemptions to Obama's prohibition against charging higher premiums for some people with pre-existing medical conditions, but the subsidies would be lower, Pearson said, making coverage less unaffordable.

Like the House bill, the Senate measure would block federal payments to Planned Parenthood. Many Republicans have long fought that organization because it provides abortions.

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It would also bar the use of the bill's health care tax credits to buy coverage that includes abortions, a major demand for conservatives. That language could be forced out of the bill for procedural reasons, which would threaten support from conservatives, but Republicans would seek other ways to retain the restriction.

The Senate would provide $50 billion US over the next four years that states could use in an effort to shore up insurance markets around the country.

For the next two years, it would also provide money that insurers use to help lower out-of-pocket costs for millions of lower income people. Trump has been threatening to discontinue those payments, and some insurance companies have cited uncertainty over those funds as reasons why they are abandoning some markets and boosting premiums.

The nonpartisan Congressional Budget Office said the House bill would cause 23 million people to lose coverage by 2026. The budget office's analysis of the Senate measure is expected in the next few days.

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