Senate leaders put final touches on health care bill

WASHINGTON — Senate leaders on Wednesday were putting the final touches on legislation that would reshape a big piece of the U.S. health care system by dramatically rolling back Medicaid while providing a softer landing to Americans who stand to lose coverage gained under the Affordable Care Act compared to legislation passed last month by the House.

A discussion draft circulating Wednesday afternoon among aides and lobbyists would roll back the ACA’s taxes, phase down its Medicaid expansion, rejigger its subsidies, give states wider latitude in opting out of its regulations and eliminate federal funding for Planned Parenthood.

The bill largely mirrors the House measure that narrowly passed last month but with some significant changes. While the House legislation pegged federal insurance subsidies to age, the Senate bill would link them to income as the ACA does. The Senate proposal cuts off Medicaid expansion more gradually than the House bill, but would enact deeper long-term cuts to the health care program for low-income Americans. It also removes language restricting federally-subsidized health plans from covering abortions, which may have run afoul of complex budget rules.

Senate Majority Leader Mitch McConnell, R-Ky., intends to present the draft to wary GOP senators at a meeting on Thursday morning. McConnell has vowed to hold a vote before senators go home for the July Fourth recess, but he is still seeking the 50 votes necessary to pass the major legislation under arcane budget rules. A handful of senators from conservatives to moderates are by no means persuaded that they can vote for the emerging measure.

Aides stress that the GOP plan is likely to undergo more changes in order to garner the 50 votes Republicans need to pass it. Moderate senators are concerned about cutting off coverage too fast for those who gained it under Obamacare. Conservatives don’t want to leave big parts of the ACA in place.

The Senate bill would give states more leeway in opting out of the ACA’s insurance regulations through expanding the use of so-called “1332” waivers already embedded within the law. But it wasn’t yet clear Wednesday evening whether the waivers would go so far as allowing insurers to charge patients with preexisting conditions more – or even denying them coverage altogether.

Moderates who are on the fence about whether to support the Obamacare overhaul are likely to be pleased at the bill’s approach to subsidies because they would be based on financial need, potentially preserving coverage for more people who got insured under the ACA.