Senate GOP Health Bill Slashes Medicaid, Reshapes Obama Law

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The individual mandate and the employer mandate are also expected to be completely eliminated.

McConnell is hoping to push the measure through the Senate next week. Under the Affordable Care Act, states can apply for "innovation waivers" exempting them from parts of the law and allowing them to determine their own health care systems, to an extent.

The major health insurance companies made a tactical decision to work with Republicans on their plan to repeal and replace Obamacare rather than lobby to stop it. Overall, however, the cuts to Medicaid are deeper than those in the House bill.

Senate Majority Leader Mitch McConnell says he'll give senators a draft of the bill Thursday. It would also let states get waivers to ignore some coverage standards that "Obamacare" requires of insurers. Doubts about the future of these payments, which were created to help offset the cost of providing below-market rate premiums for low-income consumers, has led many insurers to withdraw their plans from the exchanges, severely limiting, and in some cases eliminating, options for people seeking insurance. A score of the bill from the Congressional Budget Office could be available as soon as Friday.

A small group of Republican senators has written the bill in secret in recent weeks, with many Americans and even some fellow Republicans eagerly awaiting details about what's in the bill.

"We've long called for a better way forward, and we've engaged in intensive talks on how to get there", McConnell said. But most senators said they haven't read the text of the legislation and withheld comment about their support.

Sources say top Senate Republicans are finalizing their plan for dismantling President Barack Obama's health care law.

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Senator Susan Collins, a moderate Republican from ME, said she wants to read an assessment by the nonpartisan Congressional Budget Office (CBO) on its impact on cost and insurance coverage before making her decision. The expansion allowed people with incomes between 100 percent and 138 percent of the poverty level to enroll in Medicaid, a joint federal-state program whose enrollment requirements were stricter prior to the ACA.

If the Senate approves a bill next week, it still has more hurdles to go.

In January 2013, Gov. Susana Martinez was one of the few Republican governors to accept the expanded insurance program, approved at a time when the state was seeing an increase in revenue from higher energy prices. Starting in 2020, that threshold would be lowered to 350 percent under the Senate bill - but anyone below that line could get the subsidies if they're not eligible for Medicaid. But what we're learning from the Senate version of the bill is that it actually cuts Medicaid more deeply than the House bill; it just waits longer to do it.

The question, then, is how much money Republicans want to put in - or, more to the point, take out - of the health-care system?

Defeat of the House-passed bill wouldn't necessarily end the health care debate in Congress, but it would redefine it.

Some of the Senate bill's provisions could be political land mines, with individual senators' reactions to it crucial to determining whether or not the Affordable Care Act, popularly known as Obamacare, survives a Republican attack that has been under way since its passage in 2010.

Insurers would be required to sell policies to people with pre-existing conditions and could not charge sick people higher premiums than healthy people.

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