Senate Republicans Release Draft Affordable Care Act Replacement Bill

June 22, 2017

Senate Republicans released a discussion draft of their bill to repeal and replace the Affordable Care Act (ACA) this morning. Although the draft differs from the House-passed healthcare bill in a number of ways, it does take many of its key provisions from the House Republicans’ American Health Care Act (AHCA), which was passed in May.

The Senate’s discussion draft is similar to the House-passed bill in the following ways:

• Steep cuts to Medicaid that limit its spending in future years
• Drastic reductions in the ACA’s open-ended tax subsidies and elimination of ACA’s tax increases
• States could receive waivers to opt out of some of the ACA’s consumer protections including provision of “essential health benefits”
• A ban on funding for Planned Parenthood for one year

The Senate’s bill does break with the House bill on a number of key points. These points include:

• A longer transition period
• A three-year phase-out of the ACA’s Medicaid expansion beginning in 2020, compared to the immediate ending in 2020 of the Medicaid expansion called for in the House bill
• A lower reimbursement rate for states under Medicaid
• A slower growth rate for Medicaid spending
• The continued provision of cost-sharing subsidies to insurers to cover costs of low-income Americans participating in the ACA insurance exchanges at least through 2019
• Tax credits provided in the measure would be based on both income and age, as opposed to the House bill which based tax credits solely on age
• States could not waive consumer protections for people with pre-existing health conditions
• No abortion restrictions on the tax credits used in the insurance exchanges

The Senate's ACA replacement bill was crafted by a small handful of Republican Senators with no input from Democrats and very little input from Republicans outside of the small group. Furthermore, Senate Republicans do not intend to hold any committee hearings on the bill. Some Senate Republicans have voiced frustration that the process has been so secretive. Nearly 75% of Americans said Senate Republicans should discuss their health care plans publicly, according to a CBS News poll released Tuesday.

A cost estimate of the Senate bill from the nonpartisan Congressional Budget Office (CBO) is expected to be released early next week. Senate Majority Leader Mitch McConnell (R-KY) aims to hold a vote on the legislation before policymakers leave at the end of next week for their week-long July 4th recess.

Democrats immediately condemned the draft upon its release this morning. Senate Minority Leader Chuck Schumer (D-NY) noted that the president had asked for a bill with more "heart" than the House bill, but this bill is "every bit as bad" as the House version and may be "meaner." "The way this bill cuts health care is heartless," Senator Schumer said on the floor earlier today. "This bill will result in higher costs, less care and millions of Americans will lose their health insurance, particularly through Medicaid," Sen. Schumer said.

Because they are using a process called budget reconciliation, Republicans only need a simple majority to pass their bill. That means if all Democrats vote against the bill, the bill could still pass as long as no more than two Republicans vote against it.

Even if Senate Republicans are successful in passing the bill, the legislation will still need to be reconciled with the version passed by the House in early May. The fate of the ACA replacement legislation therefore remains highly uncertain.