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Senate GOP Releases Updated Healthcare Bill

by Countable | 7.13.17

On Thursday, Senate Majority Leader Mitch McConnell (R-KY) released an updated draft of the healthcare bill GOP senators have been working on in the weeks since the House passed the American Health Care Act.

McConnell has been struggling to build support for the proposal within the Republican ranks, with several of the caucus’ 52 senators wavering about supporting legislation that’d need the support of 51 lawmakers to start debate and at least 50 votes (plus the vote of VIce President Mike Pence) to pass. Leadership hopes to hold votes on the proposal next week.

Here are the latest updates to the draft bill:

  • An additional $70 billion would be provided to states to enact their own reforms through things like cost-sharing, Health Savings Accounts (HSA), and other ideas. That’s in addition to the $112 billion in funding for those purposes already in the bill.

  • Individuals would be allowed for the first time to use funds from their HSAs to pay for premiums, which is something the Joint Committee on Taxation and Congressional Budget Office have said would increase coverage.

  • Individuals enrolled in catastrophic health insurance plans would be eligible for premium assistance tax credits, unlike under Obamacare. Such plans would have higher deductibles that cover three primary care visits a year and have federal protections limiting an individual’s out-of-pocket costs.

  • An additional $45 billion would be provided for substance abuse treatment and recovery. The earlier Senate draft of the bill provided an additional $2 billion above the $15 billion contained in the House passed bill.

  • Some existing taxes would remain in place, such as the net investment income tax, the additional Medicare Health Insurance Tax, and the remuneration tax on executive compensation for health insurance.

  • A fund would be created to make payments to certain health insurance providers for the costs of covering high risk individuals. To qualify, the insurer would have to offer sufficient minimum coverage on an exchange that complies with Obamacare’s Title I mandates (no denial of coverage for pre-existing conditions, kids on parents’ plans until age 26, etc.). By offering such coverage, insurers would be allowed to offer plans off the exchange that don’t comply with all of the Title I mandates..

There are also several Medicaid specific changes made by the latest draft:

  • States would be allowed to include individuals covered by the Obamacare Medicaid expansion under their new block grants if they choose to do so.

  • If a public health emergency is declared, state medical assistance in a particular part of the state wouldn’t count toward the per capita caps or block grant allocations during the emergency.

  • States can apply for a waiver for the purpose of continuing and/or improving home and community based services for elderly, blind, and disabled populations.

  • To allow for more accurate Disproportionate Share Hospital (DSH) decisions and maximum benefits to help provide uncompensated care, DSH would be calculated on a per uninsured patient basis rather than a per Medicaid enrollee basis.

These changes aren’t a wholesale makeover to the Senate’s earlier draft of the bill, a summary of which you can find here.

Tell your senators what you think of the most recent draft of the GOP's healthcare bill using the Take Action button.

— Eric Revell

(Photo Credit: Gage Skidmore via Flickr / Creative Commons)

Countable

Written by Countable

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  • Leslie
    07/13/2017
    ···

    Any bill that deprives the poor, the sick and the needy of healthcare is an inhumane and inexcusable bill. Any lawmakers with a conscience should vote against this heinous bill that would leave 23 million kicked off of insurance and lead to the PREVENTABLE DEATH of thousands.

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  • Susan
    07/13/2017
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    This so-called revised health care bill still guts Medicaid, Planned Parenthood and dumps millions from coverage. Vote no. Please do not help McConnell salvage his pride. Take care of Nevadans

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  • Drmarknd
    07/13/2017
    ···

    It's STILL trash. Health care is not a product to be sold in different sizes and prices. For profit health care is the problem with health care in this country.

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  • Pauline
    07/13/2017
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    I think they should fix Obamacare. Why dismantle something that has been working. Fund it so insurance companies will stay in market.

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  • Joanne
    07/13/2017
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    NO NO NO to trump care. Single payer for all. Trumpcare 2.0 is out--it still blocks women from PP & is the worst bill for women in a generation. Keep saying NO. Thank you.

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  • Follow-NO-One
    07/13/2017
    ···

    Health care should be a right! My medicines alone would cost $700 a month without Medicaid. I have more pre-existing issues than Quaker has oats. Approve of this insult of a bill and you are signing my death warrant. Death and voter suppression. Only the poor will die and the intelligent poor vote Democratic. If this joke of a bill passes people like me will die! Be on the right side of history or we will come after your seats even with our dying breaths. This from a lifelong Independent Colorado voter.

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  • Elizabeth
    07/13/2017
    ···

    Senators Moran and Roberts. I have said this quite a lot lately. Vote NO to this new healthcare of Trumps. The ACA was a fairly good plan but just needs tweaking and fixing a bit. Yes taxes would go up if you stayed with a single payer plan but the benefits of it are well worth those tax increases. No person would be left to suffer or possibly die with this system in place. If your parents are still alive, how would you feel if they were unable to receive medication or medical care due to lack of insurance or god forbid a sudden pre-existing condition they could get? What about your children or grandchildren? Will your wives, daughters or even granddaughters have proper care? Remember it is the women who will bear the children for your families and others. If they are not taken care of properly have you thought how that would effect the boys, that you all so highly regard, if they had some condition that could have been avoided if the mother had had proper prenatal care? Please think about how this can and will affect your family and your families future children and grandchildren. VOTE NO!!!! IMPROVE the ACA not repeal or replace it!!!!

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  • Monica
    07/13/2017
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    To be clear: the new version of Trumpcare deems maternity care, mental health treatment and prescription drugs as essential for Members of Congress but not the rest of Americans. Really?!? Seriously?!?

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  • JulieFaloon
    07/13/2017
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    Please stand up for the common man's rights. We are so advanced as a society that we can mine asteroids but we cannot take care of each other?? If we have the ability to keep each other healthy why don't we?

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  • Mark
    07/13/2017
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    This update to the bill on health care is still going to leave millions without any coverage or very poor coverage. Vote no.

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  • Brian
    07/13/2017
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    Once again the Republican Party serves up a steaming pile of crap and expects the American people to just let it happen

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  • Shaun
    07/13/2017
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    I've yet to see anything from my reps to fix healthcare. It's time for you to reach across the aisle and fix this mess. The American people don't care who's name is on it. We only care that it works for Americans.

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  • Debbie
    07/13/2017
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    https://draftable.com/compare/YQqISKezkQIt. The medical community vehemently opposes. Why does a small group of 13 men get to decide the fate of the nation's Medicaid care? Work with ACA, hold public hearings and don't rush through a major change that causes harm!!!!!!!! Please vote no. Look in the mirror and ask yourself if you care about your fellow humans in this country. We are heading done a dangerous path.

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  • Sharon
    07/13/2017
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    From The New York Times, July 13, 2017: The numbered questions/remarks are mine: On Premiums: “….the bill would allow insurers, under certain conditions, to offer health plans that did not comply with standards in the Affordable Care Act. Under that law, insurers sell regulated health plans through a public insurance exchange in each state. But health care experts worried that such a change would send healthy consumers to low-cost, basic health plans, leaving sick and older consumers to buy more comprehensive health policies at much higher prices. To compensate, Republican leaders added billions of dollars to try to offset rising premiums.” According to USA Today, July 13, 2017: “Because insurers would also be able to sell plans that don’t meet the ACA’s requirements, that would segment the market into sick and healthy people. Insurance companies say that would destabilize the market and increase costs for people with pre-existing conditions.” “In another change, people who enroll in catastrophic health insurance plans would be eligible for federal tax credits to help pay premiums. Such plans typically have lower premiums and high deductibles. But under the Affordable Care Act, consumers generally cannot use the tax credits for such plans. The bill would, for the first time, allow people to use tax-favored health savings accounts to pay insurance premiums. Republicans said this policy change would increase health care coverage.” 1. What does “offset” mean? It doesn’t sound like “reimburse fully”. 2. Although the new bill allows tax credits to offset higher premiums under catastrophic plans. The Times notes that such plans also have much higher deductibles. If your deductible is $6,000, you live on $1,000 a month on Social Security because you are disabled or elderly, and a visit to the doctor (you might under these conditions have more than one doctor to see regularly to survive or maximize functioning) costs on average $130-180 (from Blue Cross-Blue Shield) how much are tax credits toward premiums going to help you with 50% of your annual income on the line? 3. The bill allows premiums to be paid by funds in health savings accounts to pay premiums, but the higher premiums still take more from you, since it was your disposable income paid into those accounts and the premiums are still likely to be higher if you have any medical issues or are older – and older in health insurance terms doesn’t mean 80 – so, it seems to me coverage for any of us is going to cost us more and, proportionately, more for the elders and poor among us because those groups are most at risk medically resulting in higher costs anyway. Also, not mentioned in the Times article, but which I believe I read elsewhere, the Republican bills would cap the amount allowed to be deposited into “tax-favored” health savings accounts which even limits your ability to prepare to be your own health care cost safeguard. 4. According to USA Today, July 13, 2017, The bill would still sunset in two years cost-sharing subsidies for low- and middle-income people who purchase insurance on an exchange. But it now includes an additional $70 billion – up from $112 billion – for states to reduce insurance costs in other ways. States would have to match the funds. Given that so many state governments have in the majority Republicans who are committed to reducing the costs of government and taxes for the average citizen as well as already strained budgets, it seems dangerous to rely on the states’ ability or willingness to produce matching funds. It seems likely there would be little to no help meeting premium costs. On Medicaid: “But the new bill, like earlier versions, would still convert Medicaid from an open-ended entitlement to a system of fixed payments to states. In the event of a public health emergency, state Medicaid spending in a particular part of a state would not be counted toward the spending limits, known as per capita caps, ….” “Like the previous bill, it would end the requirement that most Americans have health coverage, and it would make deep cuts to Medicaid, capping payments to states and rolling back its expansion under the Affordable Care Act. Though some Republican senators expressed concern about how the previous bill would affect Medicaid, Senate leaders stuck with the same approach in the new version.” 1. Again, throwing the poor, disabled, and elderly under the bus of Republican antipathy to Obamacare, which antipathy which remains unexplained in objective terms and appears only founded in zeal to obstruct and/or undo everything and anything Obama did. 2. If payments to states are capped, how does that affect the per person payout? Could a nursing home resident reach a payment cap and be affected as a result? What about a person receiving in-home care? These are important questions we all should be asking because we could all need nursing home or in-home care as some of us live a distance from families, have no meaningful extended family relationships, or are childless. On Pre-existing Conditions According to USA Today’s July 13, 2017 article: “The plans that don’t meet the ACA’s requirements would not have to accept sick people, according to Larry Levitt, senior vice president at the Kaiser Family Foundation. And the bill would make it easier for states to waive requirements that insurance plans cover specific benefits, which could make it difficult for those with expensive health conditions to find affordable plans. Like the earlier version, the new bill would also still end the ACA's requirement that insurers spend a specific amount of the premiums they collect on benefits, instead of on profits, administration and other expenses.” 1. Back to devaluing the poor, the elderly, the disabled and, now, those with chronic illnesses. On the elderly According to USA Today, July 13, 2017, “The bill would still eliminate the ACA's requirement that insurers can't charge older customers more than three times what younger customers pay for the same coverage. Instead, those in their 60s could be charged five times as much, or more. “ 1. I might hope insurers would not take advantage of the vulnerable elderly, most of who live on a fixed income with limited possibility of working to better their situation, but insurers and their shareholders are about profit. I find it unlikely they would not take more from those they perceive need and cost more. This Bill has, in my eyes, the same problems as the others only more skillfully concealed. I do not support this Bill and ask that you stand against it.

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  • Lisa b.
    07/13/2017
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    Stop giving into the insurance companies and the Senate elitists that they fund. I worked in healthcare for 10 years and saw how they treated their clients before and after ACA. If they are not forced to cover all clients, then their greed will win out and all of us will lose. We need to fix the issues with ACA and stop trying to reinvent the wheel.

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  • Margaret
    07/13/2017
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    It's time to acknowledge that republicans do NOT want to improve the health care situation in our country. You feel that you HAVE to pass something because you've been yelling about it for 7 years. I find it utterly appalling that you are willing to harm your constituents, rural hospitals, rural communities and seniors! I am 61 years old. I only missed ONE election in my voting life due to car trouble. If you vote in favor of this abomination I will make it my mission to ensure that you are not re-elected. STOP! Work with democrats to improve the ACA.

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  • Matthew
    07/13/2017
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    This (Non)Health (Un)Caring "bill" is total BS. Trash it! Fight it!

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  • Brady
    07/13/2017
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    This is still a bad bill that will take health care away from millions of Americans. Let's not forget that the original proposal would cut $700+ BILLION from Medicaid, so these measly increases don't come close to mitigating the issues. Especially in the middle of an opioid epidemic, one that is hitting Tennessee hard, any cuts to Medicaid and other programs that could help to stem the tide are unacceptable.

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  • Ellen
    07/13/2017
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    The bill is still 'mean' to coin a phrase from #45. Vote no

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  • Lana
    07/13/2017
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    Take money out of the military budget and put it into fixing and improving ACA. The United States should not have third world health care for its citizens.

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