WASHINGTON — The closely guarded Senate health care bill written entirely behind closed doors finally became public Thursday in a do-or-die moment for the Republican Party’s winding efforts to repeal Obamacare.
The unveiling of the legislation marks the first time the majority of the Senate GOP conference gets a comprehensive look at the health care proposal.
With Majority Leader Mitch McConnell pressing ahead for a vote next week, senators are likely to have only a handful of days to decide whether to support or vote against the bill.
While the Senate bill is largely similar to the House passed-bill, there are some key differences.
Medicaid has been one of the central sticking points in the debate. The bill would continue the enhanced Medicaid expansion funding from Obamacare until 2021 and then phase it out over three years.
This is a concession to moderates, who weren’t pleased the House version would end the enhanced support for new enrollees in 2020.
However, conservatives also get some of what they want when it comes to overhauling the entire Medicaid program.
The Senate bill would keep the House plan to send a fixed amount of money to states each year based on enrollment or as a lump sum block grant.
But it would shrink the program even more over time by pegging the annual growth rate of those funds to standard inflation instead of the more generous medical inflation, starting in 2025.
This would likely force states to cut enrollment, benefits or provider payments.
The Senate bill would also largely maintain Obamacare’s premium subsidies structure, but tighten the eligibility criteria starting in 2020.
Fewer middle class people would get help because only those earning up to 350 percent of the poverty level would qualify instead of the 400 percent threshold contained in Obamacare.
But it would also open the subsidies to enrollees below the poverty level so those living in states that didn’t expand Medicaid could get some assistance.
Senators opted to keep Obamacare’s subsidies to prevent the funds from being used for abortions.
The House bill called for creating tax credits based largely on age, but adding abortion restrictions to these credits could have run afoul of Senate rules governing the bill.
Still, the similarities to Obamacare will likely infuriate conservatives such as Kentucky Sen. Rand Paul, who decried the House version as “Obamacare Lite.”
Also, as in the House bill, it would defund Planned Parenthood for one year.
The Senate also backs away from some last-minute House concessions to conservatives that would have allowed states to opt out of several protections for those with pre-existing conditions, but insurers would not be allowed to charge higher premiums to those with pre-existing conditions.
The bill would also aim to shore up the existing Obamacare market by allocating funds for the cost-sharing subsidies until 2019.
This will placate insurers, who were distraught by President Donald Trump’s refusal to commit to continue making these payments, leading many carriers to hike rates or drop out of the exchanges for 2018.
McConnell’s decision to keep the details tightly under wraps until Thursday was intentional and aimed at winning over his colleagues out of the public spotlight, but the secretive process has infuriated Democrats — and aggravated plenty of Republicans, too.
“I need the information to justify a ‘yes’ vote. I have a hard time believing that we would have that in such a short period of time,” Sen. Ron Johnson, R-Wisconsin, said Wednesday.
South Carolina Sen. Lindsey Graham joked: “We’ll know if it’s a boy or girl tomorrow.”
McConnell has very little room for error — he can only lose two Republican votes and still pass the bill.
Trump said Wednesday night he hopes to “surprise” with a plan that has “heart.”
“I hope we are going to surprise with a really good plan,” Trump said at a campaign rally in Cedar Rapids, Iowa. “You know I’ve been talking about a plan with heart. I said add some money to it. A plan with heart, but Obamacare is dead.”
The House passed its version of health care reform last month, but while Republicans celebrated that bill with Trump at the White House, the president has since called it “mean.”