Posted by on June 22, 2017 3:20 pm
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Categories: 111th United States Congress American Health Care Act barack obama Cadillac insurance plan Congressional Budget Office Department of Health and Human Services Economy Federal assistance in the United States federal government Federal Tax Health Health in the United States Healthcare reform in the United States Internal Revenue Code Internal Revenue Service Labor Medicaid Medicare Mitch McConnell New York Times obamacare Patient Protection and Affordable Care Act Patient Protection and Affordable Care Act replacement proposals Planned Parenthood Federation of America Politics Presidency of Barack Obama Presidency of Lyndon B. Johnson republican party Senate Short-Term Stabilization Fund Social Issues State Innovation Fund Statutory law Twitter United States United States National Health Care Act

Update 2:  Here is a live feed of Senators offering up their initial reactions:

Lindsey Graham is encouraged…

GRAHAM SAYS LIKELIHOOD OF GETTING 50 VOTES FOR HEALTHCARE BILL “IS GREATER TODAY THAN I THOUGHT YESTERDAY”

…while Chuck Schumer is not…

*SCHUMER: SENATE NEEDS MORE TIME THAN 10 HOURS TO DEBATE BILL

All very shocking.

Update 1:  Senate Republicans have just released their official 142-page healthcare bill.

Here are some initial takeaways:

  • Ends ACA mandates for individuals AND employers 

  • Funds the ACA’s cost-sharing subsidies through 2019 but then only provides tax credits for people with incomes up to 350% of the federal povery level

  • Tax cuts largely similar to those in the House bill. That includes repealing a 3.8% tax on investment income retroactively to January 2017 and delaying the repeal of a 0.9% payroll tax until 2023

  • Contributes $62 billion to a “State Innovation Fund”

  • Seeks funding for insurers through 2021

  • Allows ‘children’ to stay on parental plans until the age of 26

  • Bill suspends ‘Cadillac Tax’ on employer health plans through 2025

Medicaid:  The plan would roll back the Affordable Care Act’s Medicaid expansion more gradually than the House version would, but would ultimately make deeper cuts to the program. While states’ funding from Washington would be capped for the first time in the history of the Medicaid program, states would be given a choice of the formula used — ‘block grants’ or ‘per capita caps’ — to curb it under the bill.

Planned Parenthood: The bill would strip federal funding from Planned Parenthood Federation of America for one year. It also prohibits tax credits from being used to purchase plans that offer abortion coverage.

Senate Republicans provided additional summary details here:

Short-Term Stabilization Fund: To help balance premium costs and promote more choice in insurance markets throughout the country, this stabilization fund would help address coverage and access disruption – providing $15 billion per year in 2018 and 2019; $10 billion per year in 2020 and 2021.

Cost-Sharing Reductions: Continues federal assistance – through 2019 – to help lower health care costs for low-income Americans in the individual market.

Long-Term State Innovation Fund: Dedicates $62 billion, over 8 years, to encourage states to assist high-cost and low-income individuals to purchase health insurance by making it more affordable.

Tax Credits: Targeted tax credits will help defray the cost of purchasing insurance; these advanceable and refundable credits – adjusted for income, age and geography – will help ensure those who truly need financial assistance can afford a health plan.

Health Savings Accounts: Expanded tax-free Health Savings Accounts to give Americans greater flexibility and control over medical costs; increased contribution limits to help pay for out-of-pocket health costs and to help pay for over-the-counter medications.

Repeals Obamacare Taxes: Repeal costly Obamacare taxes that contribute to premium increases and hurt life-saving health care innovation, like the taxes on health insurance, prescription drugs, medical devices, and “high-cost” employer sponsored plans.

Empowers states through state innovation waivers (Obamacare 1332 Waiver): Provide states additional flexibility to use waivers that exist in current law to decide the rules of insurance and ultimately better allow customers to buy the health insurance they want.  Allow the Department of Health and Human Services (HHS) to fast-track applications from states experiencing an Obamacare emergency.

Preserve access to care for Americans with pre-existing conditions, and allow children to stay on their parents’ health insurance through age 26. (There are no changes to current law as it applies to Veterans, Medicare, or Social Security benefits.)

Strengthen Medicaid for those who need it most by giving states more flexibility while ensuring that those who rely on this program won’t have the rug pulled out from under them.

Targets Medicaid to Those Most in Need: In 2021, begins gradual reductions in the amount of federal Obamacare funds provided to expand Medicaid, restoring levels of federal support to preexisting law by 2024 while providing fairness for non-expansion states.

New Protection for the Most Vulnerable:  Guarantees children with medically complex disabilities will continue to be covered.

Provides additional state flexibility to address the substance abuse and mental health crisis.

Flexibilities for Governors:  Allows states to choose between block grant and per-capita support for their Medicaid population beginning in 2020, with a flexibility in the calculation of the base year.  Allows states to impose a work requirement on non-pregnant, non-disabled, non-elderly individuals receiving Medicaid.

New Protections for Taxpayers: Curbs Medicaid funding gimmicks that drive up federal costs.

And here is the official text of the 142-page healthcare bill:

* * *

Here is our update from earlier:

After weeks of drafting in private, much to the dismay of Chuck Schumer, details of the Senate’s healthcare bill are set to be revealed today.  While we’re still awaiting the official text of the bill, the New York Times, courtesy of leaks from some D.C. lobbyists, has previewed some of the details which apparently include large cuts to Medicaid, an end to the “mandate” that requires everyone to have health care and a repeal of “virtually all the tax increases imposed by the Affordable Care Act.”

Senate Republicans, who have promised a repeal of the Affordable Care Act for seven years, took a major step on Thursday to achieve that goal as they unveiled a bill to end the health law’s mandate that nearly everyone have health care, remake and cut the Medicaid program and create a new system of federal tax credits to help people buy health insurance.

The Senate bill — once promised as a top-to-bottom revamp of the health bill passed by the House last month — instead maintains its structure, with modest adjustments. The Senate version is, in some respects, more moderate than the House bill, offering more financial assistance to some lower-income people to help them defray the rapidly rising cost of private health insurance.

But the Senate measure, like the House bill, would phase out the extra money that the federal government has provided to states as an incentive to expand eligibility for Medicaid. And like the House measure, it would put the entire Medicaid program on a budget, ending the open-ended entitlement that now exists.

It would also repeal virtually all the tax increases imposed by the Affordable Care Act to pay for itself, in effect handing a broad tax cut to the affluent, paid for by billions of dollars sliced from Medicaid, a health care program that serves one in five Americans, not only the poor but two-thirds of those in nursing homes. The bill, drafted in secret, is likely to come to the Senate floor next week, and could come to a vote after 20 hours of debate.

Bloomberg has provided additional details:

The plan, to be released Thursday after a private Senate GOP meeting, includes $15 billion a year in market-stabilizing funds over the next two years and $10 billion a year in 2020 and 2021, the person said.

It also would provide $62 billion allocated over eight years to a state innovation fund, which can be used for coverage for high-risk patients, reinsurance and other items. The draft bill would phase out Obamacare’s expansion of Medicaid over three years, starting in 2021.

The assessment being made by senators will be shaped in part by an analysis of the bill to be released by the Congressional Budget Office, the official scorekeeper on Capitol Hill.

Of course, time is of the essence as the deadline for insurers to finalize their coverage and pricing plans for 2018 is just around the corner on August 16th.

Meanwhile, with the bill now up for debate and all 48 Democrats expected to vote ‘no’, the race is on to figure out which Republicans will join them.  Of course, Mitch McConnell can only afford to lose 2 Republican votes which would result in a tie and leave Mike Pence the deciding tie-breaker vote.

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