The Senate's Version of Trumpcare is Out - Here's What You Need to Know

June 22nd 2017

Mike Rothschild

After weeks of secret negotiations and meetings, Senate Republicans released their version of the replacement plan for the Affordable Care Act (ACA).

While the Senate's bill appears to be similar to the version that passed the House in May, there are significant changes, which pundits and Democratic Senators alike are scrambling to read, as Senate Majority Leader Mitch McConnell seeks to hold a vote on the bill as soon as early next week.

According to an instant analysis by CNN, Buzzfeed, the Washington Post, and others, the new bill is more moderate than the House version, but still makes dramatic changes to the American health care system, rolling back ACA provisions, dramatically cutting Medicaid, and cutting taxes for the wealthiest Americans.

Notable changes between the House and Senate versions appear to include:

  • Tying health insurance subsidies to income, as opposed to age, which the House bill did. This mitigates one of the biggest criticisms of the AHCA, which is that it would drive up out-of-pocket costs for the poor and elderly.
  • A slower phase-out to the Medicaid expansion, repealing it in 2024, rather than 2020, which the House intended to do.
  • Paradoxically, the Senate bill has deeper cuts to Medicaid, even more than the projected $830 billion that the Congressional Budget Office (CBO) determined would be slashed from the low-income health program by the House.
  • The Senate bill removes language restricting federally subsidized health plans from covering abortions, which likely would have violated Senate procedural rules. It still defunds Planned Parenthood, but only for one year.
  • The new bill does away with some last minute House amendments that would have allowed states to opt out of protections for pre-existing conditions, and prohibits insurers from charging higher premiums to those with pre-existing conditions.
  • While reports claimed that the Senate was thinking of keeping certain ACA taxes, the Senate bill repeals all of them other than the tax on high-cost "Cadillac" health plans.

The next step is that the Congressional Budget Office will score the bill to determine its cost and effect on the insurance market. The Senate will then hold the mandated 20 hours of debate on the bill, then take a vote some time next week. With a 52-48 Republican majority, McConnell can only lose two votes and still pass the bill. If the bill does pass, it will have to be reconciled with the House version, and a final version will be sent to President Donald Trump for signature.