The Slatest

Here’s What’s in the Senate’s Revised Health Care Bill

Senate Majority Leader Mitch McConnell speaks about the health care bill in June alongside Sen. John Thune, left, and Sen. John Barrasso.

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Senate Republicans on Thursday released a revised version of their bill to repeal and replace Obamacare, with changes aimed at placating more members to ensure the bill’s passage. From the New York Times:

Republicans said the revised bill would provide roughly $70 billion in additional funds that states could use to help reduce premiums, hold down out-of-pocket costs and otherwise make health care more affordable. The bill already included more than $100 billion for such purposes. The new bill, like earlier versions, would convert Medicaid from an open-ended entitlement to a system of fixed payments to states. But in the event of a public health emergency, state Medicaid spending in a particular part of a state would not be counted toward the spending limits, known as per capita caps.


In a departure from current law, the bill would allow insurers, under certain conditions, to offer health plans that did not comply with standards in the Affordable Care Act. Under that law, insurers sell regulated health plans through a public insurance exchange in each state.

The last paragraph refers to provisions proposed by Texas Sen. Ted Cruz, who has pushed for allowing individuals to purchase cheaper insurance plans that cover less than Obamacare requires. That concession and the inclusion of provisions allowing the use of Health Savings Accounts to pay for premiums may win over conservatives starting with Cruz himself. The bill also includes concessions aimed at winning over moderates including $45 billion in funding to address opioid addiction, the preservation of Obamacare taxes on wealthy Americans, and $70 billion in additional funding for states trying to stabilize premiums and out-of-pocket costs.


The CBO is expected to release a score for the revised bill on Monday or Tuesday. Slate’s Jim Newell wrote about the anticipated changes to the bill on Wednesday.

The CBO is analyzing two versions of the new bill: one with the Cruz amendment, and one without it. The score of the one with the amendment will likely be a bludgeoning, as just about every expert predicts it will send premiums for the Obamacare-compliant plans, which those with pre-existing conditions need, spiraling out of control. Senators are still working on adjustments to the Cruz amendment that could—could! theoretically!—defang its worst effects, as I wrote about yesterday. But those won’t appear in the bill that’s released tomorrow. (The Cruz amendment would also have to pass muster with the Senate parliamentarian. As it happens, I saw the estimable Elizabeth MacDonough in the hall on Wednesday and attempted to gossip with her about this very issue. It was not fruitful.)

[…]The discussions will still be fluid even after the “new” bill is released. Leaders are telling concerned Republican senators that they can try to change the bill during the open amendment process that follows the first procedural vote, expected next week. “I think it would be safe to assume that a fully amendable bill, after the motion to proceed,” Missouri Sen. Roy Blunt said, “should give everyone a sense that they’ll have an opportunity to make whatever point they want to make.”

That procedural vote on the bill is expected by the end of next week.