GOP's challenge: finding votes for Senate health care bill

"The chaos the Republican Party is wrecking across our health care system won't just be felt in our insurance markets but in doctor's offices, ER's and clinics across the state of in", says Myers. The government could offer tax credits sufficient to help almost everyone buy at least catastrophic coverage, require insurers to take care of sick people at favorable rates if they had kept their insurance current, and provide adequately funded high-risk pools for anyone who fell through the cracks.

He accepts that though a significant step, "ACA was not flawless, nor could it be the end of our efforts - and that if Republicans could put together a plan that is demonstrably better than the improvements we made to our health care system, that covers as many people at less cost, I would gladly and publicly support it". Its analysis of the Senate bill is expected early next week, a day or two before the vote. Medicaid covers health care for nearly 40 percent of America's children.

The Senate bill would phase out extra money Obama's law provides to 31 states that agreed to expand coverage under the federal-state Medicaid program. The federal share drops to 90 per cent after 2020. Medicaid covers some 70 million people, from newborns to elderly nursing home residents.

Shortly after the 142-page bill was distributed, more than a half-dozen GOP lawmakers signaled concerns or initial opposition.

When Cassidy says Medicaid enrollees will see lower premiums under the Senate's restructure, that's likely true.

Senate GOP bill: Stretches phase-out of Medicaid expansion financing. Higher payments would be provided through 2023. Over the long run, both Senate and House bills would change federal reimbursement for Medicaid to a per capita basis.

The bill also opens the door for controversial requirements mandating that Medicaid beneficiaries have a job in order to be eligible.

This is what's known in the insurance business as a "death spiral": more and more expensive customers with fewer and fewer healthy ones in any given year to cover the costs.

House GOP bill: To be protected, consumers must avoid a break in coverage of more than 63 days. Those who let their coverage lapse pay a 30 percent premium penalty for a year. The bill would bar using tax credits to buy coverage that includes abortions.

Instead, a complicated and most likely ineffective state waiver process has been substituted for a clear repeal.

The subsidies would also be calculated based on premium costs for less comprehensive plans. But bronze plans have an average deductible of almost $6,100. It's a recipe, in other words, for unstable insurance markets.

Obama law: Insurers can not charge their oldest customers more than 3 times what they charge young adults.

AARP called it an "Age Tax".

He writes that "the legislation rushed through the House and the Senate without public hearings or debate would do the opposite". House Republicans needed two attempts before they successfully crafted and approved their own repeal bill without bipartisan support.

Here are the key aspects of the Senate bill to keep in mind.

Obama law: Requires all insurance plans to cover services from 10 broad "essential services", including hospitalization, office visits, prescriptions, maternity and childbirth, substance abuse treatment, rehabilitation, and preventive services, including birth control at no additional charge for women.

If you're on Medicaid, the Senate bill could impact you in several ways.

Also, unlike Obamacare, the Senate bill would provide more generous subsidies to enrollees in their 20s and 30s who qualify for aid.

The doubts about the latest plan from Washington came from Republicans, Democrats and the nation's one independent governor. It eliminates most of the taxes imposed on the well-to-do to pay for Obamacare.

Senate GOP bill: Tax cuts very similar to House bill, though some would be delayed. However, they must collect a separate premium, strictly segregated from taxpayer funds.

First, the Senate's plan would shift the calculation for subsidies. That way it would be impossible to game the system by going without insurance and then buying it once sick.

  • Joanne Flowers