(CN) — Senate Republicans on Thursday rolled out their version of a replacement for the Affordable Care Act that includes a curb on Medicaid expansion, an end penalties for people not buying insurance and cuts taxes for the wealthy.
But the bill, which was crafted during weeks of closed-door meetings, faces long odds. Senate Majority Leader Mitch McConnell can afford only three defections among his ranks and to secure passage he’s going to have to walk a tightrope, appeasing moderates while keeping conservatives who want far deeper cuts on board.
More than half a dozen GOP senators have expressed problems with the measure, and a defeat would be a humiliating setback for Trump and McConnell on one of their party’s top priorities.
“We have a responsibility to move forward, and we are,” McConnell said Wednesday afternoon.
In a departure from the version the House approved last month, it would also largely retain the subsidies Obama provided to help millions buy insurance, which are pegged mostly to people’s incomes and the premiums they pay.
The House’s tax credits were tied to people’s ages, a change the nonpartisan Congressional Budget Office said would boost out-of-pocket costs to many lower earners. Starting in 2020, the Senate version would begin shifting increasing amounts of tax credits away from higher earners, making more funds available to lower-income recipients, some officials said.
The details of the plan were first reported by The Washington Post.
In a separate report, the Associated Press said the documents McConnell plans to release Thursday might suggest optional approaches for issues that remain in dispute among Republicans.
That could include the number of years the bill would take to phase out the extra money Obama provided to expand the federal-state Medicaid program for the poor and disabled to millions of additional low earners.
The House-passed bill would halt the extra funds for new beneficiaries in 2020. But Republicans from states that expanded Medicaid, like Ohio’s Rob Portman, want to extend that phase-out to seven years.
The Senate proposal would also impose annual limits on the federal Medicaid funds that would go to each state, which would tighten even further beginning in 2025. Unlimited federal dollars now flow to each state for the program, covering all eligible beneficiaries and services.
Like the House bill, the Senate measure would block federal payments to Planned Parenthood, two sources said. Many Republicans have long fought that organization because it provides abortions. But it was unclear if, or how, the Senate would follow the House’s path and forbid the use of health care tax credits to buy coverage that includes abortions.
Such a prohibition is a major demand by conservatives, but special rules the Senate is using to ease passage of the legislation restrict the policy changes the measure can include.
The Senate would end the tax penalties Obama’s law created for people not buying insurance and larger employers not offering coverage to workers. The so-called individual mandate — aimed at keeping insurance markets solvent by prompting younger, healthier people to buy policies — has long been one of the GOP’s favorite targets.
To help pay for its expanded coverage to around 20 million more people, Obama’s law increased taxes on higher income people, medical industry companies and others, totaling around $1 trillion over a decade. Like the House bill, the Senate plan would repeal or delay those tax boosts. – Developing story.