CNN says this is what THEY KNOW about the Senate Obamacare bill…and it doesn’t look good

CNN is out with a new report on the Senate healthcare bill, aka the Obamacare replacement bill, and here’s what they say they know about the bill thus far.

In short Medicare reform is further reformed; the Community Rating can no longer be waived by states; States will get more federal money to help insurance companies; and lastly the new tax credit subsidies will be increased.

Read more from CNN:

Medicaid reform

An under appreciated element of the House bill was the extent to which it dramatically reformed the Medicaid program.

The Senate bill would keep that overhaul, curtailing federal support by sending states a fixed amount per enrollee, known as a per capita cap. This change, along with eliminating funding for Medicaid expansion, would reduce spending on the program by at least $800 billion over 10 years. States would also have the option of receiving a lump sum each year as a block grant, in return for even more flexibility on how to administer the program.

Regulatory waivers

The waiver issue was all the rage in the House, and behind closed doors, has certainly been an area of contention in the Senate.
Senate leaders have decided to address the most contentious issue head on — they plan to remove the waiver option for community rating, which bans insurers from charging higher premiums to those with pre-existing conditions. They will leave, or add, waivers for the following regulations:

  • Essential Health Benefits, which requires insurers to cover 10 main services.
  • Medical Loss Ratio, which mandates insurers spend at least 80% of premiums on patient care.
  • Actuarial Value, which dictates the average share of health care costs insurers must pick up.
  • Age Rating Band, which restricts how much more insurers can charge older enrollees compared to younger ones.

And a note of caution: There is still no guidance as to whether these waivers will survive the Senate parliamentarian and be allowed to be in the final bill.

State stability fund

The House included $138 billion to help states and insurers cover pricey patients in a variety of ways, primarily through things like high risk pools, and to help lower consumers’ costs.

This will be in the Senate bill as well, but several moderate senators have pushed for *significantly* more money for this fund. It’s unclear how much will be added, but a sizable amount is likely needed to pacify senators like Susan Collins, who gave a private presentation on Maine’s now-defunct high risk pool and noted for it to be taken nationwide.

Of note, adding money to this fund (to the tune of $8 billion, targeted for those with pre-existing conditions in states that opted out of community waiver regulations) was positively *essential* to House Republicans passing their bill. This is a natural home for plussing up funding to appease senators (and a certain Oval Office inhabitant) wary of, say, charges that the bill is “mean.”

Tax credits

The House bill eliminated the Affordable Care Act’s subsidies, which are based on income and cost of coverage, and replaced them with tax credits based mainly on age that started at $2,000 per year and peaked at $4,000 a year.

That structure, according to analysts and Republicans alike, fell far short when it came to providing adequate financial help for lower income and older Americans.

The Senate is expected to make the tax credit more generous for these groups. There’s also been a significant push from people like Alaska Sen. Lisa Murkowski to add a geographic adjustment to the credit — something essential to ensuring her state isn’t disproportionately hammered by the new subsidy structure. However, it could also further alienate conservatives, who are already upset that the tax credits are too similar to Obamacare’s subsidies.

To what degree all of this would be implemented — or if it all makes it in the final structure — remains somewhat unclear, but the House bill included an $85 billion placeholder for the Senate to utilize, so there is room to maneuver in what would be a crucial component of securing moderate Republican support.

So it sounds like the House bill has gone from bad to worse in the Senate as they spend more of our tax money to appease Senators, at least based on this reporting. I guess we’ll find out more tomorrow.

CNN also lays out what’s still up in the air as well as what they say may lock in wavering votes. You can read the full article here.


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