Here Is The Full Text Of The Republican Healthcare Bill

Update 2:  Here is a live feed of Senators offering up their initial reactions:

Lindsey Graham is encouraged...

GRAHAM SAYS LIKELIHOOD OF GETTING 50 VOTES FOR HEALTHCARE BILL "IS GREATER TODAY THAN I THOUGHT YESTERDAY"

...while Chuck Schumer is not...

*SCHUMER: SENATE NEEDS MORE TIME THAN 10 HOURS TO DEBATE BILL

All very shocking.

Update 1:  Senate Republicans have just released their official 142-page healthcare bill.

Here are some initial takeaways:

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  Ends ACA mandates for individuals AND employers 

  
  


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  Funds the ACA"s cost-sharing subsidies through 2019 but then only provides tax credits for people with incomes up to 350% of the federal povery level

  
  


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  Tax cuts largely similar to those in the House bill. That includes repealing a 3.8% tax on investment income retroactively to January 2017 and delaying the repeal of a 0.9% payroll tax until 2023

  
  


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  Contributes $62 billion to a "State Innovation Fund"

  
  


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  Seeks funding for insurers through 2021

  
  


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  Allows "children" to stay on parental plans until the age of 26

  
  


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  Bill suspends "Cadillac Tax" on employer health plans through 2025

  
  

Medicaid:  The plan would roll back the Affordable Care Act’s Medicaid expansion more gradually than the House version would, but would ultimately make deeper cuts to the program. While states" funding from Washington would be capped for the first time in the history of the Medicaid program, states would be given a choice of the formula used -- "block grants" or "per capita caps" -- to curb it under the bill.

Planned Parenthood: The bill would strip federal funding from Planned Parenthood Federation of America for one year. It also prohibits tax credits from being used to purchase plans that offer abortion coverage.

Senate Republicans provided additional summary details here:

Short-Term Stabilization Fund: To help balance premium costs and promote more choice in insurance markets throughout the country, this stabilization fund would help address coverage and access disruption – providing $15 billion per year in 2018 and 2019; $10 billion per year in 2020 and 2021.

Cost-Sharing Reductions: Continues federal assistance – through 2019 – to help lower health care costs for low-income Americans in the individual market.

Long-Term State Innovation Fund: Dedicates $62 billion, over 8 years, to encourage states to assist high-cost and low-income individuals to purchase health insurance by making it more affordable.

Tax Credits: Targeted tax credits will help defray the cost of purchasing insurance; these advanceable and refundable credits - adjusted for income, age and geography - will help ensure those who truly need financial assistance can afford a health plan.

Health Savings Accounts: Expanded tax-free Health Savings Accounts to give Americans greater flexibility and control over medical costs; increased contribution limits to help pay for out-of-pocket health costs and to help pay for over-the-counter medications.

Repeals Obamacare Taxes: Repeal costly Obamacare taxes that contribute to premium increases and hurt life-saving health care innovation, like the taxes on health insurance, prescription drugs, medical devices, and “high-cost” employer sponsored plans.

Empowers states through state innovation waivers (Obamacare 1332 Waiver): Provide states additional flexibility to use waivers that exist in current law to decide the rules of insurance and ultimately better allow customers to buy the health insurance they want.  Allow the Department of Health and Human Services (HHS) to fast-track applications from states experiencing an Obamacare emergency.

Preserve access to care for Americans with pre-existing conditions, and allow children to stay on their parents’ health insurance through age 26. (There are no changes to current law as it applies to Veterans, Medicare, or Social Security benefits.)

Strengthen Medicaid for those who need it most by giving states more flexibility while ensuring that those who rely on this program won’t have the rug pulled out from under them.

Targets Medicaid to Those Most in Need: In 2021, begins gradual reductions in the amount of federal Obamacare funds provided to expand Medicaid, restoring levels of federal support to preexisting law by 2024 while providing fairness for non-expansion states.

New Protection for the Most Vulnerable:  Guarantees children with medically complex disabilities will continue to be covered.

Provides additional state flexibility to address the substance abuse and mental health crisis.

Flexibilities for Governors:  Allows states to choose between block grant and per-capita support for their Medicaid population beginning in 2020, with a flexibility in the calculation of the base year.  Allows states to impose a work requirement on non-pregnant, non-disabled, non-elderly individuals receiving Medicaid.

New Protections for Taxpayers: Curbs Medicaid funding gimmicks that drive up federal costs.

#Obamacare has been a disaster from day one. It"s time that Americans received #BetterCare. https://t.co/M1mEJGTZW6

— Leader McConnell (@SenateMajLdr) June 22, 2017

And here is the official text of the 142-page healthcare bill:

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Here is our update from earlier:

After weeks of drafting in private, much to the dismay of Chuck Schumer, details of the Senate"s healthcare bill are set to be revealed today.  While we"re still awaiting the official text of the bill, the New York Times, courtesy of leaks from some D.C. lobbyists, has previewed some of the details which apparently include large cuts to Medicaid, an end to the "mandate" that requires everyone to have health care and a repeal of "virtually all the tax increases imposed by the Affordable Care Act."

Senate Republicans, who have promised a repeal of the Affordable Care Act for seven years, took a major step on Thursday to achieve that goal as they unveiled a bill to end the health law’s mandate that nearly everyone have health care, remake and cut the Medicaid program and create a new system of federal tax credits to help people buy health insurance.

The Senate bill — once promised as a top-to-bottom revamp of the health bill passed by the House last month — instead maintains its structure, with modest adjustments. The Senate version is, in some respects, more moderate than the House bill, offering more financial assistance to some lower-income people to help them defray the rapidly rising cost of private health insurance.

But the Senate measure, like the House bill, would phase out the extra money that the federal government has provided to states as an incentive to expand eligibility for Medicaid. And like the House measure, it would put the entire Medicaid program on a budget, ending the open-ended entitlement that now exists.

It would also 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 sliced from Medicaid, a health care program that serves one in five Americans, not only the poor but two-thirds of those in nursing homes. The bill, drafted in secret, is likely to come to the Senate floor next week, and could come to a vote after 20 hours of debate.

Bloomberg has provided additional details:

The plan, to be released Thursday after a private Senate GOP meeting, includes $15 billion a year in market-stabilizing funds over the next two years and $10 billion a year in 2020 and 2021, the person said.

It also would provide $62 billion allocated over eight years to a state innovation fund, which can be used for coverage for high-risk patients, reinsurance and other items. The draft bill would phase out Obamacare’s expansion of Medicaid over three years, starting in 2021.

The assessment being made by senators will be shaped in part by an analysis of the bill to be released by the Congressional Budget Office, the official scorekeeper on Capitol Hill.

Of course, time is of the essence as the deadline for insurers to finalize their coverage and pricing plans for 2018 is just around the corner on August 16th.

What"s next for the ACA marketplaces? Two more important dates, which @bjdickmayhew described to me perfectly. https://t.co/csGWOAopXJ pic.twitter.com/nlyey0lRvb

— Bob Herman (@bobjherman) June 22, 2017

Meanwhile, with the bill now up for debate and all 48 Democrats expected to vote "no", the race is on to figure out which Republicans will join them.  Of course, Mitch McConnell can only afford to lose 2 Republican votes which would result in a tie and leave Mike Pence the deciding tie-breaker vote.

House Republicans Release Plan To Repeal and Replace Obamacare: Key Highlights

Update: A seemingly angry (judging by the tone) Senate minority leader Chuck Schumer obviously had to lash out and dismiss the Republican"s plan for "TrumpCare"...

"Trumpcare doesn"t replace the Affordable Care Act, it forces millions of Americans to pay more for less care. This plan would cut and cap Medicaid, defund Planned Parenthood, and force Americans, particularly older Americans, to pay more out of pocket for their medical care all so insurance companies can pad their bottom line.

It cuts taxes on the rich to make middle class families pay more. To make matters worse, this sham of a replacement would rip treatment away from hundreds of thousands of Americans dealing with opioid addiction, breaking the President"s word that he would expand treatment, not cut it.

This bill is a giveaway to the wealthy and insurance companies at the expense of American families, and Senate Democrats will work hard to see that it is defeated."

Wow, sounds like a nightmare. Let"s see what the bill actually says.

As we detailed earlier, on Monday afternoon, House Republicans in both the Ways and Means and Energy and Commerce committees, unveiled their long-awaited legislation as part of House Republicans effort to repeal and replace Obamacare through the reconciliation process. The measure would roll back the government"s health care role and is expected to result in fewer people having insurance coverage; however, due to strong opposition among key republicans to the proposed plan, there is a high likelihood the bills will not pass in their current form.

Upon releasing the legislation, House Energy and Commerce Committee Chairman Greg Walden said: “After years of Obamacare’s broken promises, House Republicans today took an important step. We’ve spent the last eight years listening to folks across this country, and today we’re proud to put forth a plan that reflects eight years’ worth of those conversations with families, patients, and doctors. Simply put, we have a Better Way to deliver solutions that put patients – not bureaucrats – first, and we are moving forward united in our efforts to rescue the American people from the mess Obamacare has created.

“With today’s legislation, we return power back to the states - strengthening Medicaid and prioritizing our nation’s most vulnerable. We provide the American people with what they’ve asked for: greater choice, lower cost, and flexibility to choose the plan that best suits their needs. Today is just the first step in helping families across this country obtain truly affordable health care, and we’re eager to get this rescue mission started.”

The plan would dismantle the key aspects of ObamaCare, including subsidies to help people buy coverage, the law"s fines on people who don"t purchase health insurance, the expansion of Medicaid, and drop the plan to tax employer-sponsored plans. The bills can be found here and here.

A breakdown of core aspects removed from the existing law (courtesy of Axios):

• All Obamacare taxes


• All Obamacare subsidies, including its premium tax credit


• Individual, employer mandate penalties


• "Cadillac tax"


• No longer will limit the tax break for employer-sponsored health coverage


• No payments to insurers for cost-sharing reductions


• Selling insurance across state lines (can"t be done in the "reconciliation" bill)


• Medical malpractice reform (can"t be done in the "reconciliation" bill)

What is being added:

• Pre-existing condition coverage


• Continuous coverage — 30 percent penalty if people don"t keep themselves insured


• Special fund to help states set up "high-risk" pools, fix their insurance markets, or help low-income patients


• Enrollment in expanded Medicaid will be frozen


• Current enrollees can stay until 2020, and keep getting extra federal funds, until they leave the program on their own


• Medicaid will change to "per capita caps" (funding limits for each person) in fiscal year 2020


• A new, refundable tax credit will be available in 2020 to help people buy health insurance


• Covers five age groups — starts at $2,000 for people in their 20s, increases to $4,000 for people in their 60s


• It"s not means tested, but phased out for upper-income people (starting at $75,000 for individuals, $150,000 for families)


• Insurers can charge older customers five times as much as young adults

At its core, in place of the existing Affordable Care Act legislation, republicans will implement a system centered on a tax credit to help people buy insurance.  That tax credit would range from $2,000 to $4,000 annually  increasing with age. That system would provide less financial assistance for low-income and older people than ObamaCare, but could give more assistance to younger people and those with somewhat higher incomes.

Democrats have warned that between the phasing out of ObamaCare’s Medicaid expansion and the smaller tax credit for low income people, coverage would be put at risk for many of the 20 million people who gained it from ObamaCare. As The Hill adds, Republicans acknowledge that their plan will cover fewer people, but note that unlike ObamaCare, they are not forcing people to buy coverage through a mandate. They say their system is less intrusive and provides people a tax credit without mandates or a range of tax increases.

While some republicans such as House Ways and Means Chairman Kevin Brady are confident the bill will pass with full Republican support despite recent party infighting over the details, the measure faces a rocky path, particularly in the Senate.

Earlier on Monday, four Republican senators - Sens. Rob Portman, Shelley Moore Capito, Cory Gardner and Lisa Murkowski - objected to an earlier version of the House bill, saying that it failed to protect ObamaCare’s Medicaid expansion, saying they won"t support a bill that takes the same approach to the program as a leaked Obamacare repeal and replacement bill did. However, under the proposed bill, the repeal of the Medicaid expansion would not take effect until 2020, and Republicans would grandfather in current enrollees so that they can stay on the program. Once 2020 arrives, the federal government will no longer provide the extra federal funds that allow for expansion.

As this is unlikely to solve the senators" problems with the bill, the proposed plan may be dead on arrival.

That plan has drawn objections from more centrist Republican senators too, who want to protect the expansion and are worried about constituents losing coverage and their states losing federal funds. 

House Republicans have also objected to the plan, with Conservatives in the House Freedom Caucus calling the bill"s tax credit is a “new entitlement.” They have enough votes to kill the bill, but it remains to be seen whether they will actually vote against it.

As previously leaked, the bill would maintain ObamaCare’s protections for people with pre-existing conditions, who could still not be denied coverage. Instead of ObamaCare’s mandate, the bill would seek to incentivize healthy people to sign up by allowing insurers to charge people 30 percent higher premiums if they have a gap in coverage. The measure also repeals ObamaCare’s taxes, such as the medical device tax and health insurance tax, starting in 2018.

Finally, The Hill also notes that the bill scraps a controversial Republican proposal in earlier drafts to start taxing some employer-sponsored health insurance. Instead, the measure would keep ObamaCare’s "Cadillac tax" on generous healthcare plans starting in 2025, in order to prevent that legislation from adding to the deficit in that decade.

House committees planned votes on the legislation Wednesday at 10:30am. That will launch perhaps the year"s defining battle in Congress, and GOP success is by no means assured because of internal divisions.

Republican Version Of 'Cadillac Tax' In Obamacare Replacement Drawing Fire From Employers And Unions

Back in 2009, the Obama administration drew a lot of fire from employers and labor unions over Obamacare"s so-called "Cadillac Tax", a tax on healthcare premiums over a certain threshold.  Apparently, the United Auto Workers in the Midwest had grown accustomed to their unlimited supply of Viagra, completely free of charge, and were unwilling to "go down" without a fight.

Fast forward eight years and now several Republican plans for replacing the ACA include their own curb on generous health plans: a cap on how much of employer-provided health benefits could be shielded from taxes. Such a cap could force certain workers to start paying income tax on a portion of the cost of their coverage.

Currently, when an employee receives health insurance, the value of that benefit isn’t subject to either income or payroll taxes. On average, employer coverage for a single worker last year ran $6,435, while for a family, the tab was $18,142, according to a survey by the Kaiser Family Foundation. Employers bore about 82% of the cost for single plans, and about 70% for family coverage.

While the Republican plan would limit the deductibility of premium payments as opposed to implementing a special tax, as the Wall Street Journal points out, “in the end, they both would have similar effects,” including pushing companies toward skinnier health plans, according to Steve Wojcik, an official with the National Business Group on Health, which represents employers. “It’s six of one, a half-dozen of the other.”

Of course, many politicians in Washington D.C. view a tax on "Cadillac" plans as a huge revenue opportunity that could add $20 billion annually to federal coffers by 2025.

House Speaker Paul Ryan (R., Wis.) said recently he has long supported a cap on the health-benefits tax exclusion, but that it was an “open question” where Congress would end up on the issue. Mr. Hatch in a statement said, “We must study the open-ended tax preference and its impact on costs for employees and increased spending by employers.”

The tax exclusion for employer health benefits represents a huge pool of potential federal revenue, estimated at $266 billion in 2016, according to the Congressional Budget Office. Capping the exclusion would bring in a small fraction of that total. The Cadillac tax, the CBO said, would raise federal revenue by $2 billion in 2020, growing to $20 billion in 2025—money that could help defray the cost of expanded health coverage under the ACA.

That said, it"s not just C-suite executives who would be hit by the "Cadillac tax" as many unionized employees are also at risk, after decades of negotiating ever better healthcare plans far in excess of what their counterparts in non-unionized, private-sector jobs get.

Still, the current proposals to limit the tax exclusion are drawing sharp pushback from employers, which say the change could limit their flexibility and add to their costs, and labor groups, which fear their members could end up paying additional taxes. A December letter to members of Congress that criticized both the Cadillac tax and the health-benefits exclusion cap was signed by groups including the U.S. Chamber of Commerce and the National Retail Federation.

The cap is also drawing opposition from the Alliance to Fight the 40, a coalition that lobbies against the Cadillac tax, which would impose a 40% levy on the value of health plans above certain cutoff levels. Last month, the group, which includes employers, unions and health companies, paid to blast an ad at electronic devices in the vicinity of congressional Republicans’ Philadelphia retreat, with the message: “Taxes on employer-sponsored health care are a bad idea.”

Members of unions that have negotiated robust health benefits are among those likely to be hit by taxes tied to high-cost plans. Capping the health-benefits exclusion “would be a huge tax increase on the middle class,” said D. Taylor, president of Unite Here, which represents hospitality workers.

Meanwhile, economists have long said the tax exclusion for health benefits has negative effects, encouraging employers to offer too-generous health coverage. That, they argue, leads to excessive health spending because employees are shielded from the full cost of medical care.  The existing health-benefits tax exclusion “has been an important factor in promoting the kinds of inefficiencies in the health-care system that we have seen,” said Joseph Antos, an expert at the conservative-leaning American Enterprise Institute, who supports a cap on the employer health-benefits tax exclusion.

Of course, the real question is how Trump"s largely unionized supporters in Michigan, Wisconsin and Pennsylvania will respond to an assault on their unlimited chiropractic visits, "therapeutic" massages and Viagra.