Senate GOP releases bill to cut Medicaid, alter 'Obamacare'

Former President Barack Obama ripped into the newly released Senate Republican Obamacare replacement plan in a Facebook post Thursday, saying the legislation is "not a health care bill" and contains "fundamental meanness".

The Senate version delays cuts to the Medicaid program and maintains tax credits included in Obama's signature Affordable Care Act to help lower income Americans purchase health insurance for at least two years. (This is known as the "community rating".) Here the Senate is breaking with the House health care bill, which allows states to remove those protections and give insurers more pricing flexibility if they choose.

The subsidies enabling low-income people to buy private health insurance are expected to be linked to recipients' income in the Senate bill, a "major improvement" from a measure approved last month by the U.S. House of Representatives that tied them exclusively to age, Republican Senator Susan Collins said.

- Senate debates the bill and Majority Leader Mitch McConnell, R-Ky., said senators will have an opportunity to offer amendments to add to or change the bill.

The Senate bill largely uses people's incomes as the yardstick for helping those without workplace coverage to buy private insurance.

The Senate now has 52 Republicans and 48 Democrats.

Democrats said the measure would result in skimpier policies and higher out-of-pocket costs for many and erode gains made under Obama that saw roughly 20 million additional Americans gain coverage. This bill is just as bad as the House bill, taking coverage away from millions of people and making huge cuts to Medicaid. The budget office's analysis of the Senate measure is expected in the next few days. But it would be more gradual than the House bill, which cuts off the extra funds for new Medicaid beneficiaries in 2020. The Senate bill would allow states to apply for waivers from those regulations. However, they said they were "open to negotiation and obtaining more information". The Senate bill also proposes eliminating many ACA taxes, and the employer penalties associated with the employer and individual mandates would be repealed retroactively, dating to the start of 2016. Federal law already prohibits Medicaid funds being used to pay for abortions, so the funding cut would affect other services like contraception and STD and HIV screenings.

Jane McNichol, an organizer of the Protect Our Care CT campaign, holds up a clothesline with photos of Connecticut residents opposed to repeal of the Affordable Care Act, during a rally on the state Capitol steps, Thursday, June 22, 2017, in Hartford, Conn.

But if the bill doesn't do enough to control health care costs and roll back enough of Obamacare, Republicans will lose the support of some of the more conservative Republicans. The program now gives states all the money needed to cover eligible recipients and procedures.

The tax was part of Obama's health law, and it has always been unpopular among Republicans, as well as business groups and labor. It has come under widespread criticism from Democrats and helped prompt some moderate House Republicans to vote against the measure. Susan Collins, R-Maine, said the centrist has some misgivings about the bills as well.

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