All about the Senate Health Bill

This week in Congress was all about the health bill – from speculation about the content and complaints about the opaque process in the beginning of the week to analysis and commentary after the Thursday release.

Also this week: the President signed the VA Accountability Act and new revelations surfaced about Russian efforts to hack the 2016 election.

Senate Health Bill Released

On Thursday, Senate GOP Leadership released the "Better Care" health care discussion draft, the Senate's amendment to the House-passed American Health Care Act.

Let's take a look at three big angles on the bill:

1. The Content (What's in it? What would it do?)
2. The Politics (What are the chances it gets 50 votes in the Senate?)
3. The Process (What comes next?)

1. The Content (What's in it? What would it do?)

The bill would:

• Repeal the individual mandate
• Repeal the employer mandate
• Repeal ACA taxes on wages above $200,000, medical devices, prescription drugs and indoor tanning
• Medicaid: phases out states' expansion starting in 2021, caps federal funding per enrollee
• Eliminates subsidies for out-of-pocket costs after 2019
• Lowers income level for premium subsidies from 400% of federal poverty level ($47,550 annual income) to 350% FPL $42,000
• Allows states to apply for waivers to eliminate requirement of coverage for "essential benefits" (like ambulance, emergency services, hospitalizations, maternity care, mental health, prescription drugs, rehabilitation, lab services, prevention and wellness, pediatric services)
• Preserves ban on lifetime limits (but states can apply for waivers to eliminate)
• Preserves requirement that insurers offer coverage regardless of preexisting conditions
• Allows insurers to charge older people up to five times as much as younger ones (only 3x allowed currently)
• Increases amount that can be put tax-free into health savings account
• Keeps ability for children to stay on parents' plans until age 26

More Resources: The Hill, RollCall, WaPo, USAToday, Chicago Trib, NYTimes

Source: New York Times

2. The Politics (What are the chances it gets 50 votes in the Senate?)

As a reconciliation bill, the Better Care plan only needs 50 votes to pass (with VP Pence as the tie-breaker). That means two Republicans could defect and the bill still pass. The question is – will the bill move left to pick up moderates or right to pick up conservatives? 
 

Follow the "Whip Counts" from NYTImes, CNN, 

This divide is clear even from the comments that have been registered on POPVOX – a majority of constituents oppose the bill: some think it goes too far in repealing the existing system, some think it does not go far enough.

Constituent sentiment registered on POPVOX on 
Senate Republican Health Care bill (discussion draft)

Right now the Senators on the fence are:

Moderates:

Dean Heller [R, NV]: "I cannot support a piece of legislation that takes away insurance from tens of millions of Americans and hundreds of thousands of Nevadans" 

Susan Collins [R, ME]: "It's going to be an open amendment process and I'm sure many of us are going to have amendments. In addition, I want to see that CBO analysis because I don't know the exact impact yet." (link)

Rob Portman [R, OH]: "I continue to have real concerns about the Medicaid policies in this bill, especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic" 

Conservatives:

Joint statement from Sens. Rand Paul [R, KY], Mike Lee [R, UT], Ted Cruz [R, TX], Ron Johnson [R, WI]:

Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor… There are provisions in this draft that represent an improvement to our current health care system but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs"

3. The Process (What comes next?)

• The Senate will negotiate informally over the next few days, hearing concerns from members and looking to secure 50 votes.
• A CBO score (explaining how much the bill will cost, how many will be covered, and other analysis of its impacts) will come out next Monday or Tuesday
• The Senate will vote on a "motion to proceed" to the bill (requires 51 votes)
• Senators will vote on amendments
• After amendments, the Senate will vote on the actual bill (no 60-vote cloture requirement) – it needs 50 votes to pass, with VP Mike Pence potentially casting a tie-breaking vote
• The bill will then head back over to the House, where it could either be amended again – or, if the House has enough votes, it could pass with no further changes
• It would then be signed into law by President Trump

Questions from POPVOX Nation

You sent some great questions about the health bill! 

Tom W: How much is it going to cost in lost taxes?
Great question! This is information we can expect to learn from the Congressional Budget Office report, expected Monday or Tuesday. This nonpartisan agency runs the bill through its mathematical model to predict its impacts and costs. Stay tuned!

Cathy H: I'm covered under my employer's health care insurance. How will this affect me?
The Senate bill like the American Health Care Act in theHouse, would eliminate the “employer mandate” that requires employers to provide health insurance or pay a fine. While your employer may opt to continue to provide a health insurance plan for employees, there will be no penalty if they choose not to.

I want to know how the proposed Senate Health Care bill addresses services to illegal/undocumented people in the US.  Will they "qualify" for : Marylyn B
Undocumented immigrants are currently not eligible to buy Marketplace health coverage, or for premium tax credits and other savings on Marketplace plans. The Senate bill applies to "qualified aliens" as defined in Section 431 of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA).healthcare under this new law? 

Steve B: Why does this bill have to be so complicated? I have tried to read the summary and some of the text of the Bill and it reads like a bunch of drunk lawyers wrote it.
We loved this ;-)… and YES, while the bill language is complicated, it's really the only way to actually change existing laws.. you have to go in and delete and edit parts of them, and that gets messy. That's why analyses like what's coming from the Congressional Budget Office next week become so important. They show how these changes impact other laws and what the overall cost will be.
 

Tell Congress what you think:
 

VA Accountability Act Becomes Law

On Friday, President Trump signed the VA Accountability Act. As reported by Federal News Radio, the bill will:

• Shorten the time employees have to respond to a disciplinary action,
• Shorten the time grievance process to 21 days,
• Expedite the appeals process for rank-and-file employees with the Merit Systems Protection Board,
• Eliminate the MSPB as an avenue for senior executives to appeal disciplinary actions. Instead, SES can appeal directly to the VA secretary and challenge the decision in the courts,
• Codify and strengthen the Office of Accountability and Whistleblower Protection, which President Donald Trump created in a recent executive order, and
• Prohibit bonuses and relocation expenses for employees who have been found guilty of wrongdoing or abuse.

Russia Investigation (Highlights)

• Must-read in-depth report on what the Obama administration knew about Russian hacking of the election and how it responded
• House Intelligence Committee met with special counsel Robert Mueller to "deconflict" the investigations
• Former Homeland Security Director Jeh Johnson told House and Senate Intelligence Committees that Russia "at the direction of Vladimir Putin himself, orchestrated cyberattacks on our Nation for the purpose of influencing our election — plain and simple."
• Senate Intelligence Committee will also investigate Russian meddling in European elections

In Case You Missed It (ICYMI) / DC

Some good news: Majority Whip Steve Scalise has been transferred out of Intensive Care

• White House not allowing cameras to cover briefings, so CNN using courtroom sketch artist
• Must-read in-depth report on what the Obama administration knew about Russian hacking of the election and how it responded
• Press team “Bad News Babes” defeated the Member team in the Congressional Softball Game
• Softball star and retiring Rep. Ros-Lehtinen “has no regrets”
• House Freedom Caucus picking up a new member in SC-5 Rep-elect Norman
• With Karen Handel win in GA-6, the House will soon have 241 Republicans & 194 Democrats (and be back to 218 as threshold for passing bills)
• Handel adds to number of women in the GOP caucus, which had been declining
• Sen. Manchin [D, VA] signed pledge “to Return to Era of Bipartisan Cooperation and Agreement” and called on colleagues to do the same
• Senate Finance Chairman Hatch [R, UT] asking for feedback on tax reform ideas
• Senators met by health care protesters at Washington’s DCA airport as they left Washington Thursday afternoon

• More than 60 lawmakers and staffers showed up for a “no-politics” bipartisan workout to mark Men’s Health Month

In Case You Missed It (ICYMI) /Nation

• If you are a registered voter, your personal data was likely exposed in the Deep Root Analytics leak
• Data exposed include individuals’ positions on gun ownership, stem cell research, and the right to abortion, religious affiliation, ethnicity – and possibly even Reddit profiles
• It’s really hot in Arizona right now
• President Trump pledged full support for LA’s bid to host the Summer Olympics
• Ooops: Caltech staffer accidentally sent out alert for 1925 earthquake
• Tick that makes you allergic to red meat is spreading
• Uber CEO out
• “Tech giants” met with the Trump Administration’s American Technology Council yesterday
• Dept. of Interior may cut 4,000 jobs in reorganization, including 1,000 at Bureau of Land Management

   

   

In Case You Missed It (ICYMI) / World

• European Union and Japan close to trade deal roughly the size of NAFTA
• Bono met with staffers to talk international affairs funding – and signed the get well card for Rep. Scalise
• NATO jet intercepted Russian defense minister’s plane
• White House lobbying to water down Russia sanctions language in the House
• King of Saudi Arabia changed the line of succession, 31-year-old son, Mohammed bin Salman, now next in line
• Is the Queen making a political statement with her hat?
• Qatar’s neighbors issued their demands

   

   

Please keep in mind that highlighting specific legislation does not imply POPVOX endorsement in any way. As always, our goal is to offer one more way to help you stay informed about the complex U.S. legislative system.