Senate Republicans released their bill to repeal and replace President Barack Obama’s healthcare law on Thursday, unveiling a proposal to slash taxes, rollback Medicaid spending, and end “Obamacare’s” individual mandate requiring most Americans to have health coverage.
The 142-page bill, crafted by 13 Senate Republicans from 10 states, is “structurally similar” to the health bill passed by the House last month, according to two Northeastern University health policy experts: Timothy Hoff, professor of management, healthcare systems, and health policy, and Gary Young, director of the Center for Health Policy and Healthcare Research.
Like the House bill, they said, the Senate bill would no longer penalize individuals and employers for failing to have health insurance. Like the House bill, it would repeal virtually all the tax increases imposed by the Affordable Care Act to pay for the program itself. And like the House bill, it would restructure Medicaid, imposing per capita spending caps.
“This is not a huge surprise,” said Young, whose research and teaching interests focus on health law and healthcare management. “It’s what people expected based on the news coverage we’ve seen over the past few weeks.”
Hoff, who studies healthcare implementation, noted that the Senate measure is a “bit softer” than the House bill. For example, he said, both bills would phase out the expansion of Medicaid eligibility, but the Senate bill would do it more slowly. Under the House bill, tax credits would be based primarily on age. Under the Senate bill, tax credits would be based primarily on age as well as income and geography.
“I think this is going to be an evolving bill,” he explained. “And I think the Senate wanted it that way.”
From bill to law
The Senate health bill is still far from law. Early next week, the Congressional Budge Office will submit a report evaluating how many people would lose their insurance due to the bill as well as its impact on the federal budget. Then, if he sticks to his timetable, Sen. Mitch McConnell, the majority leader, will put the bill up for vote in the Senate next Thursday. If it passes the Senate, it will go to the House.
“Because there are differences between the Senate and House bills, the House will either have to accept the Senate version or a conference committee will have to be formed in order to resolve the disagreements,” explained Wendy Parmet, Matthews Distinguished University Professor of Law and director of the Center for Health Policy and Law at Northeastern. If all goes according to plan, she said, Republican leaders will bring the bill to President Donald Trump in July.
According to the experts, it wouldn’t be surprising if the bill were to fail. Members from the right and left ends of the Republican Party’s spectrum have criticized the measure, with some denouncing its steep cuts to Medicaid and drug addiction efforts and others saying it’s too similar to the ACA.
The way Young sees it, McConnell’s message to his party should be: “You’re not all going to get what you want. You need to reach a consensus or the ACA will stay in place.”
If the bill is signed into law, millions of low-income and working-class Americans stand to feel the effects most acutely. Hit hardest, said Hoff, would be people on Medicaid as well as those who purchase individual health insurance plans. “Poorer and working-class Americans will eventually face more costly health insurance that may provide them with fewer benefits,” he explained. “A lot of Medicaid recipients will lose health insurance that they have gained, as the Medicaid program cuts through state block grants worsen over time and the dollars for supporting Medicaid expansion disappear.”