Senate Republicans released a revised health care bill as Majority Leader Mitch McConnell, R-Ky., continues to try to win the GOP support needed to pass a bill to repeal and replace the Affordable Care Act, on which he expects voting to begin next week.
What's new in the revised bill
The new bill includes an additional $45 billion in funding to combat the opioid epidemic and for other substance abuse treatment.
It also offers another $70 billion for states, which would be granted at federal discretion.
The legislation in addition rolls back remaining taxes on health care savings accounts, and would for the first time allow people to use money in these accounts toward insurance premiums.
And it includes money for insurance companies to help cover high-risk, expensive-to-insure populations on the individual insurance markets.
The new plan leaves in place some taxes on wealthy Americans under the Affordable Care Act, including an investment tax and a tax for highly-paid insurance company executives.
What hasn't changed
The revised bill notably would repeal most taxes under Obamacare immediately, among them the individual mandate penalty for not holding insurance as well as taxes on medical devices and indoor tanning.
The legislation also retains plans to: defund Planned Parenthood, roll back the Medicaid expansion, and allow states to apply for waivers to opt out of Obamacare regulations.
Also still in the bill are provisions to require older Americans buying individual insurance with a tax credit to pay a much-higher percentage of their income on premiums while also reducing the maximum income level for people to be eligible for a tax credit to buy individual insurance.
Conservatives previously rallied behind a proposal spearheaded by Sens. Ted Cruz, R-Texas and Mike Lee, R-Utah, that would allow insurers to offer bare-bones plans in states as long as they offer at least one plan that abides by the requirements imposed by Obamacare, including covering a list of essential health benefits. But that amendment could turn off moderates.
Some key provisions of the Cruz amendment are "included in this draft," the Texas senator said, and he appears to be warming to the bill.
"I would prefer a total repeal," said Cruz. "Unfortunately we don’t have the votes."
But moderate Sen. Susan Collins, R-Maine is still a no, tweeting Thursday afternoon that there are, "still deep cuts to Medicaid in Senate bill" and that she would vote no on any [motion to proceed].
Still deep cuts to Medicaid in Senate bill. Will vote no on MTP. Ready to work w/ GOP & Dem colleagues to fix flaws in ACA.— Sen. Susan Collins (@SenatorCollins) July 13, 2017
Medicaid spending remains a central issue, and many senators say they are still reviewing the changes in the bill.
"I think everybody is looking at the text at the bill, trying to make decisions. They’re going to try to evaluate it, digest it," said Sen. John Thune, R-S.D., adding, "There’s a discussion still going on. Everybody’s asking questions and those are being answered and discussed and points being raised, and I think that’s going to continue for a while."
Sen. Shelley Moore Capito, R-W.V. said, " I still think there are a lot of questions particularly coming from a state with a high percentage of people with pre-existing conditions."
The bill's additional funding for opioid addiction treatment brings the total to $100 billion for a health issue that is a high priority for Collins and some other GOP senators who opposed the previous version, such as Capito and Sen. Rob Portman, R-Ohio, whose states have been particularly hard-hit by the epidemic.
The other wing of the party, represented by conservatives like Sen. Rand Paul, R-Ky., also had fundamental concerns with the original bill. Paul penned an op-ed saying that the provisions in the Republican legislation that would shore up the insurance industry, in order to help them keep poor and sick people on their rolls, are in fact the opposite of repealing Obamacare.
“Shame. Shame on many in the GOP for promising repeal and instead affirming, keeping, and, in some cases, expanding Obamacare. What a shame,” he wrote for the far-right website Breitbart.
Meanwhile, Sen. Lindsey Graham, R-S.C., unveiled an alternative proposal Thursday that he said would redirect much of the current federal funding for Obamacare insurance and future funding directly to the states to use for health care spending. Graham crafted the bill with Sen. Bill Cassidy (R-La.), who is a physician.
But McConnell is still moving full steam ahead on the revised bill, saying he expects the nonpartisan Congressional Budget Office to provide its budgetary analysis, known as its “score,” early next week. The CBO score of the original GOP Senate bill estimated that 22 million more people would be uninsured under the Republican health care plan over 10 years than under current law.
The Senate Republican leader also announced this week that he would keep his chamber in session for an extra two weeks in August, although he has insisted that the additional time will be used for other must-pass legislation, including a defense spending bill and one to raise the debt limit.