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After weeks of secret, backroom negotiating in which lobbyists seem to have played a much bigger role than either senators or health care experts, Mitch McConnell is ready to release his version of Trumpcare Thursday morning—a "discussion draft"—the first step in a rushed process to get it to the floor by next Thursday. As with the House bill, the primary feature of it is that it will destroy Medicaid to provide those big tax cuts to the rich.
The plan will differ from the legislation passed in May by the House in some key ways, including a three-year phase-out of Obamacare’s Medicaid expansion beginning in 2020, according to a person familiar with the plan that was outlined to key congressional aides Wednesday night.
That’s designed to appeal to senators from states that elected to take advantage of the Medicaid expansion and didn’t want a more immediate phaseout. At the same time, the measure would provide a lower reimbursement rate for states under Medicaid.
So it will take a little bit longer to get rid of Medicaid expansion, but the cuts to the program will be larger and the program will shrink significantly, with millions of children, blind and disabled people, and seniors in nursing homes in jeopardy. This, by the way, it the first step in "entitlement reform"—they get it done with Medicaid and they have a blueprint for going after Social Security and Medicare.
To make insurers happy, at least for a year and a half, the draft would continue the cost-sharing reimbursements that have been subject to so much sabotage from Trump—but only through 2019. It would provide tax credits in place of the Affordable Care Act's direct subsidies, like the House bill, but would base them on income as well as age whereas the House bill based them just on age. It expands the ability for states to get waivers already included in the Affordable Care Act, known as 1332 waivers, letting them opt out of major pieces of the protections included in Obamacare, though reportedly will tell states they can't waive those requirements for people with pre-existing conditions. Like the House bill, it would waive the requirement that "essential health benefits" can be waived—which is a backdoor way of cutting people with pre-existing conditions loose.
It also reportedly has a one-year Planned Parenthood defunding, though it won't include the House prohibition on tax credits going to pay for plans that include abortion coverage ... yet. Senate leadership is still figuring out how they can sneak that one in since the Senate parliamentarian has said it can't be included under the rules governing the budget reconciliation process McConnell chose to pass the bill so he could avoid a Democratic filibuster.
It gets rid of all of the taxes that made Obamacare possible, including a hike in Medicare taxes on the very wealthy that added years to that programs fiscal stability. It strips millions of healthcare to pay for those tax cuts to the rich. As usual.