The Senate unveiled its version of the American Health Care Act (AHCA) on Thursday morning, briefing Republican members of the chamber before releasing the bill to the public.

The full text of the 142-page bill is available online here.

The New York Times is reporting that the legislation “would create a new system of federal tax credits to help people buy health insurance, while offering states the ability to drop many of the benefits required by the Affordable Care Act, like maternity care, emergency services and mental health treatment.”

American Hospital Association (AHA) President and CEO Rick Pollack said while America’s hospitals and health systems have been guided by a set of key principles that would protect coverage for Americans, the draft bill under discussion in the Senate moves in the opposite direction, particularly for the most vulnerable patients.

“The Senate proposal would likely trigger deep cuts to the Medicaid program that covers millions of Americans with chronic conditions such as cancer, along with the elderly and individuals with disabilities who need long-term services and support,” Pollack said in a statement. “Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance.

“We urge the Senate to go back to the drawing board and develop legislation that continues to provide coverage to all Americans who currently have it.”

Katie Smith Sloan, LeadingAge president and CEO, said the organization continues to strongly oppose the fundamental changes to the Medicaid program made by both the House and Senate legislation repealing the Affordable Care Act (ACA).

“Medicaid is not just for poor people,” Smith Sloan said. “It is the way middle-class families pay for long-term services and supports. The Senate bill actually cuts funding for Medicaid even more deeply than the House bill in the long run due to a lower annual growth rate.

“These cuts and caps on Medicaid have the potential to hurt every American family.”

Here are some of the differences between the House and Senate versions, according to a report in Roll Call:

  • The Senate bill draft would align tax credits with an individual family’s age, income and geographical location, mirroring the exact system currently in place, while the House version tied the tax credit structure solely to age.
  • Starting in 2020, the Senate version would provide subsidies up to 350 percent of the federal poverty line, a reduction from the current 400-percent ceiling.
  • The draft contains language that would effectively prevent individuals from using federal tax credits to purchase insurance plans that offer abortion coverage, a provision that was under debate the past week.
  • Unlike the House bill that would allow states to apply to waiver out some of the existing regulations, the Senate draft would tap an existing program known as “1332” waivers to help states achieve flexibility in their health care systems. The draft provides $2 billion to help with the application process.
  • In a nod to insurer demands, the proposal would also fund the health care law’s so-called cost-sharing subsidies, which help reduce health costs for lower-income people. This provision would help stabilize the insurance market but there is concern that it will violate the Senate rules which would allow for reconciliation – a rule that allows a bill to pass with 51 votes not 60.

The Senate is expected to hold a cloture vote next Wednesday which, if successful, would set up an AHCA vote on Friday, June 30. Under reconciliation, the bill requires a simple majority (51 votes) for passage. The Senate Parliamentarian will require that Democrats have sufficient time to review the final bill to bring parliamentary objections regarding the bill’s privilege to budget reconciliation expedited protections.

Leadership intends to schedule a vote on the final legislation before Congress adjourns for the Fourth of July recess.

“We will continue working with our national partners to complete further analysis and remain deeply concerned about the version of the Senate bill as it relates to the loss of coverage and Medicaid funding for our most vulnerable citizens,” said Scott A. Duke, president/CEO of the South Dakota Association of Healthcare Organizations.

Please contact Sen. Mike Rounds and Sen. John Thune to share concerns about the bill through this link.