After House Republicans passed the American Health Care Act (AHCA) in early May, the Senate GOP indicated that they would craft their own bill from scratch. But in the month since then, upper chamber Republicans appear to have made little progress. No legislation has been released, and no frameworks have been unveiled to the public.
Over the last few days, however, a few details have emerged about what the Senate bill might include. And what those reports suggest is that the revisions would shift the legislation in a direction that makes it even more like Obamacare.
The AHCA, as passed by the House, retains Obamacare's essential concept of the individual insurance market: Like the health care law, it provides a tax credit for people who purchase insurance on the individual market (albeit one that is based on age rather than income), sets up a penalty for those who go without coverage, and leaves Obamacare's major insurance regulations in place at the federal level. States would have the option to apply for federal waivers to opt out of Obamacare's preexisting conditions regulation, as well as the law's essential health benefits requirements, which require insurers to include certain categories of coverage. The AHCA would slowly roll back Obamacare's Medicaid expansion by restricting people whose coverage lapses from returning to the program. But the AHCA would not start that process until 2020, a delay that raises the possibility that for political reasons the roll back might never go into effect at all.
Many of these provisions could be altered in the Senate bill in ways that push it even closer to the health law that is already in place, according to reports that have emerged in the last week.
The tax credits for people who purchase individual market insurance are likely to be somewhat larger. The state waivers might be altered to allow states to opt-out of essential health benefits rules, but not preexisting conditions regulations. And, as of this morning, it looks as if the Medicaid rollback could be rolled back too. Republican Sen. Rob Portman told reporters today that he has put together a proposal for a seven-year "glidepath" to unwind the Medicaid expansion.
A plan to roll back the Medicaid expansion in seven years is best understood as a plan to never roll back the Medicaid expansion. As The Washington Examiner notes, Sen. Portman supported a plan to end the expansion in just two years as recently as December of 2015. Portman's rapid shift on the issue, now that Republicans control Congress and the White House, suggests the political challenges to reducing Medicaid eligibility. It's easy to imagine that years from now, another Congress—perhaps no longer controlled by Republicans—will simply vote to delay or discard a Medicaid rollback instead of letting it go into effect.
Rather than rethinking the House bill from the ground up, what Senate Republicans appear to be doing is tweaking the AHCA's existing framework, which awkwardly embraces Obamacare's core structure, rewriting the law in a way that is likely to be even more unstable and disruptive than its current iteration.
Senate Republicans, then, look intent on talking themselves into a bill that looks a lot like Obamacare but is arguably even worse, one that has few real advantages except that it allows Republicans to claim that they repealed Obamacare.