Monday night, Senate Democrats glued themselves to the Senate floor for an all-nighter in an effort to slow Senate business, as well as to resist and draw attention to the secretive actions by Senate Republicans working on the Senate’s version of an Obamacare repeal. At that time, the bill draft hadn’t even been seen by most of the Republicans within the Senate as only 13 were allowed into the closed-room sessions for its composition.
It’s been almost a decade since the Obama Administration began working on the Affordable Care Act and the process to move that bill through Congress took almost a year and a half of debating and collaborating despite the more popular narrative that it was “pushed through” and worked on “behind closed doors.” Many have called out the GOP Senators, as well as those in the House, for doing precisely what they accused Democrats of doing with what is colloquially known as Obamacare.
The House of Representatives surprised everyone when they came back to approve their version of the healthcare repeal in early May after failing to bring it to a vote in late March. At that time, Paul Ryan, Speaker of the House and perhaps the most vocal Obamacare opponent, was quoted as saying “We’re going to be living with Obamacare for the foreseeable future.”
They came back unexpectedly to vote and pass their bill on president Trump’s 105th day in office, still shy but within the range of the Roosevelt-coined “First 100 Days.”
The House’s healthcare bill removed the federal mandate for buying insurance through the Affordable Care Act marketplace as well as the tax penalties for remaining uninsured. That mandate was replaced, so-to-speak, by a prohibition on insurance companies from refusing to insure, or charging more to insure, people with pre-existing conditions. 63 days without health insurance, however, and the companies would be allowed to charge 30 percent penalties on a person’s yearly premium. According to NPR’s analysis at the time, because of tax credits based on age, the House’s bill would cause a 27-year-old making $30,000 annually to see an insurance cost increase of approximately $2,000 in Nebraska but decrease by about that amount in Washington. Everyone over the age of 60, however, would see some kind of rate increase. “The Congressional Budget Office found that, on average, older people with lower incomes would be worse off under the Republican plan than under the Affordable Care Act.”
With the state waivers provision of the bill, any state could almost essentially opt out of Obamacare entirely. The waivers, which states would have to apply for, include the ability of insurance companies charge elderly people at least five times as much as they do younger people, opt out of benefits required by the ACA like maternity coverage, mental health and prescriptions, as well as refusing coverage to, or charging more to cover, people with pre-existing conditions that include cancer and diabetes.
Perhaps most famously the report from the Congressional Budget Office (CBO) concluded that 24 million people would lose healthcare coverage or not have access to coverage as they would have under the ACA.
With the successful vote in the House the bill was the sent to the Senate where it has been worked on behind closed doors by 13 Republican Senators with no Democrats and few other Republicans. The bill was released to other Republicans and then to the public Thursday. Before many had even had time to read and analyze the bill, the Associated Press reported that four GOP senators were already prepared to oppose the current version of the bill. “Sen. Rand Paul says he and three other GOP senators oppose health bill as written, putting passage in jeopardy.” Senate Republicans could only afford to lose two Republican votes and still be able to pass the bill.
The GOP has been vowing to repeal Obamacare since it was officially signed into law, approximately 7 years ago. They added “replace” to that vow to mollify Trump and his supporters, many of whom rely on insurance provided to them by the ACA and/or Medicaid. The passage of a replacement bill in the House was a big step toward achieving that dream. The release of the Senate bill’s text ahead of a projected vote next Thursday is another step.
The bill is 142 pages and, like the House version, relies on a system of tax credits to assist people with purchasing insurance. It would also include waivers for states to drop ACA requirements like maternity care, mental health care and even emergency services. The New York Times reports that it is not a complete do-over of the House bill, as it was projected to be and is in fact a more moderate version of that bill, maintaining its same basic structure.
Many have called the House bill less of a healthcare bill and more of a tax cut for the wealthiest in the country; it looks as if the Senate bill works quite the same. It would “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 slice from Medicaid” which provides healthcare access to one out of five Americans. Those who rely on Medicaid throughout the country include those living in poverty; but, an estimated two-thirds of Medicaid recipients live in nursing homes or other similar facilities.
Writing for The Upshot, Margot Sanger-Katz calls the Senate bill a “rollback of Medicaid…The bill, of course, would modify changes to the health system brought by the Affordable Care Act. But it would also permanently restructure Medicaid, which covers tens of millions of poor or disabled Americans.”
Additionally, both the House and the Senate bills both propose defunding Planned Parenthood.
Despite reportedly calling the House’s bill “mean,” President Trump seems to approve of the Senate’s version, saying that it is “good” and would only need “a little negotiation.”
The next step is waiting for the CBO score, which is required under rules that state that the contents of such a bill can only affect the budget in certain ways; this is known as the budget reconciliation process. The CBO score, a non-partisan report. Would also reveal the approximate cost of the bill and how it would affect coverage. The CBO score is projected for release early next week.
The secrecy of the bill, the unverified reports prior to its release and its subsequent release on Thursday led to protests, some outside of Mitch McConnell’s office. McConnell is the Senate Majority leader and the primary author of the bill. Reports indicate that protesters were dragged away from his office, including some who were allegedly in wheelchairs.
Early reports indicated that McConnell was pushing for a vote as early as next Thursday. Under reconciliation, Senate democrats may only have 20 hours to debate the bill; that being said, the CBO score will be the final word on whether the bill complies with reconciliation rules. McConnell is pushing for a vote prior to the July 4th recess in order, most likely, to avoid the types of protests and heated Town Halls that House Representatives faced during their last recesses in response to their version of the repeal bill. This is also the primary reason cited as to why there has been so much secrecy surrounding the Senate’s bill; it has been an effort to avoid the same outcry and controversy. Those efforts have clearly failed, with the outcry mounting since last week and coming to a head with today’s release. Further, if McConnell fails to flip at least two of the Senators Rand Paul has cited as opposing the bill, a vote will likely not be possible at all without some revision.