Senate Republicans have been litigating their health care bill in secret. Now, Republican lawmakers say the public will only be able to see the Senate’s Affordable Care Act (ACA) replacement plan when they can secure the 51 votes needed to pass their bill.
During President Donald Trump’s working luncheon with Senate Republicans on health care reform Tuesday, Trump didn’t provide a definitive timeline when reporters asked him for one but instead said “as soon as we could do it.” Congressional sources later told the Associated Press that the president said the House health care plan is “mean” and that the Senate version should be “more generous.”
During a press conference after the working luncheon, Senate Majority Leader Mitch McConnell, sticking to message, said the senate will let the public see the bill when they finally release it. He also added that it’ll have to be a Republican-only exercise, claiming Democrats refuse to contribute.
Separately, when reporters asked how much time the public deserved to see the bill before a vote, Senate Finance Committee Chair Orrin Hatch (R-UT) said, “Well, I think we’re not worried so much about that as we are getting it together so we can get a majority to vote for it.”
There is mandatory floor debate time, which would require Senate Republicans to release the bill text. Under reconciliation, the procedural process that Republicans are using to pass legislation to avoid a filibuster, the Senate debate is limited to 20 hours. Under general rules, legislation permits unlimited debate and amendments. Senate Republicans could thus give the public only one day to unpack their health care bill.
Even though there’s limited time to unpack the Senate GOP health bill when it’s made public, leaks to reporters have provided some insight into what the bill could look like. The Center on Budget and Public Priorities (CBPP) has published its own tracker, monitoring the senate health bill.
The CBPP concluded that the Senate’s working version has “ virtually the same overall harmful impacts as the House bill.” The Congressional Budget Office estimated that the American Health Care Act (ACHA) would leave 23 million people uninsured.
Key House and Senate health bill overlaps include, but are not limited to, the Medicaid expansion phase out plan and consumer protections approach.
The AHCA would freeze Medicaid enrollments starting in 2020, effectively unraveling the expansion and leaving millions without insurance. The Senate’s health version, first reported by Axios, would phase out the Medicaid expansion by creating a three-year glide-path beginning in 2020. The Medicaid expansion gradual phaseout reportedly garnered some moderate Republican support, including from Ohio Governor John Kasich, whose state expanded Medicaid.
An immediate or gradual phase out of Medicaid expansion does nothing to preserve anyone’s coverage in the short or long run. CBPP’s Aviva Aron-Din explains that eight states that expanded Medicaid have “trigger laws” under which the expansion immediately ends if the federal government affects funds in any way. The additional 23 states that expanded Medicaid, but that do not have trigger laws, will hurt too. These states will not feel compelled to “ come up with extra funding to keep their expansions going when they know that the federal funding cuts,” said Aron-Din, thus imploding the Medicaid expansion.
Under the House plan, the federal government allows states to waive three Obamacare regulations: community rating, medical underwriting, and the 10 essential benefits. Under the reported Senate plan, states could only waive benefit standards. The end result: people with preexisting conditions under both laws still would not have access to the services they need because of expected spike costs of coverage.
Once the Senate drafts its own health bill, one that complies with reconciliation, then one of two things could happen: the House could pass the Senate version as is or conference the bill, which creates a committee to reconcile the differences. As the public currently understands the secret Senate health bill, there aren’t many differences.
This piece has been updated to include reporting from the Associated Press.