Bill Summary: The Senate framework resembles the House in many key ways, among the provisions in the draft:
Significant rollback of Medicaid expansion. The bill would maintain current funding levels for three years and then begin a three-year phase-down, just as the House bill calls for — but beginning in 2025 funding is tied to a slower growth rate than in the House bill. That would make the Medicaid program more expensive for states to operate in the years ahead, and the effect could be to drive away states from participating in the expansion.
Rolling back ACA's taxes. The Senate draft bill phases out repeals of some of the same taxes as does the House bill.
Inducements for State 1332 waivers. States get a $2 billion incentive to apply for a waiver and would be able to forgo Obamacare's insurance requirements, including one requiring states to have an exchange, as well as rules for what benefits insurers must cover, what qualifies as a health plan, and the actuarial value of the plans.
Planned Parenthood defunded for one year. Tax credits will more closely align with Obamacare than the House's structure. Beginning in 2020, the income eligibility will drop from 400 percent of the federal poverty level to 350 percent. It will also go down to 0 percent of the poverty level. If a person qualifies for Medicaid, they would not be eligible for tax credits.
Big Gives For Insurers. The bill includes two years of funding for cost-sharing reduction payments, the number one priority for insurers, according to two industry sources. But the provision could be struck under Senate rules, posing a huge question mark for the funding. Health plans have been arguing that the payments, expected to total $7 billion this year, need to continue in order to avoid chaos in the individual market. There is a big stabilization fund, including $15 billion in reinsurance funds for two years each and $10 billion the following two years. (Expect Democrats to criticize the GOP for hypocrisy — Republicans blasted Democrats for similar provisions as a "bailout" for insurance companies.) Additional funding will go to states that will have to partially cover reinsurance.
Restaurant Provisions. Retains the House language to zero out the employer mandate penalties and allows more options for reporting information to employees using the W-2, in addition of the 1095-C. Currently not included in the language but we continue to work for inclusion is, penalty relief for reporting and possibly an amendment on the 30 Hour rule.