The Senate GOP has revealed its closely guarded alternative to the American Health Care Act, which stitches together significant changes to Medicaid intended to unify disparate Republicans and modifies the House approach to Obamacare regulations in a way that still provoked the immediate ire of Democrats.
The draft legislation, which the majority nicknamed “Better Care,” also provides a different formula for insurance tax credits and reorients the purpose of the “stability fund” created by the AHCA to reimburse insurers taking on red ink.
Senate majority leader Mitch McConnell posted a handful of tweets in support of the bill shortly after the text was posted to the budget committee’s website, and GOP feedback will doubtless trickle in as lawmakers—who said they hadn’t seen the measure until just before its release—finally get their hands on a copy.
As expected, the bill rolls back Obamacare’s Medicaid expansion, but does so on the sort of “glide path” favored by senators, like Ohio’s Rob Portman, whose states expanded Medicaid. New state expansion would be cut off after three years, and the federal government would begin paying a smaller share of the cost beginning in 2021, potentially prompting states to reduce their budgets down the road. That same year, states would have the option of receiving federal Medicaid dollars via block grant or on a per capita basis. The proposal also changes the formula for Washington’s portion of Medicaid spending: Funding would grow at the rate of medical cost inflation plus 1 percentage point up to 2025, when it would then be tied to standard economic inflation. These changes could represent wins for the Portman wing and more economically conservative senators alike, as THE WEEKLY STANDARD reported earlier.
The Senate legislation does not include, as the House bill did, a controversial provision to allow states to conditionally waive an Obamacare mandate prohibiting insurers from differentiating costs based on health history. But it would allow states to widen the ratio of what insurers could charge older consumers and younger ones, and it would sunset “essential health benefit” requirements Obamacare-approved benchmark packages after 2019.
Senate minority leader Chuck Schumer was still calling the legislation “Trumpcare” despite some of its differences from the AHCA, decrying its treatment of vulnerable populations and seniors.
