Is Senate ObamaCare repeal bill too mean?

Senate Republicans negotiating their conference’s healthcare bill sought to create legislation that would repeal ObamaCare but leave a safety net in place for low-income and older Americans.

Observing the fierce backlash against the unpopular House bill, GOP senators in near unison said they would be going in a different direction.

Even President Trump got in the act, reportedly telling Senate Republicans behind closed doors that the House bill was “too mean.”

Now the Senate is coming under attack for releasing legislation that critics say would significantly raise costs on the most vulnerable.

{mosads}And their warnings are raising doubts about whether Senate Majority Leader Mitch McConnell (R-Ky.) can win the votes he needs to clear the bill through his chamber during an expected vote this week.

“I cannot support a bill that’s going to make such deep cuts in Medicaid that it’s going to shift billions of dollars of costs to our state governments,” Sen. Susan Collins (R-Maine), a key swing vote on the legislation, told ABC News on Sunday.

Collins said she was specifically worried that a bill crafted as a nicer alternative to the House legislation would hurt her state’s most vulnerable citizens.

“I’m very concerned about the cost of insurance for older people with serious chronic illnesses, and the impact of the Medicaid cuts on our state governments, the most vulnerable people in our society, and healthcare providers such as our rural hospitals and nursing home, most of whom are very dependent on the Medicaid program,” she said.

Senators took a number of steps to shift protections to low-income and older people, at least compared to the House bill.

For example, the Senate beefed up subsidies for people who need help buying insurance by ensuring that people with low incomes can get larger subsidies. Older low-income people can also get bigger subsidies under the Senate plan.

The Senate bill also provides $50 billion to help stabilize insurance markets and bring down premiums from 2018 through 2021, which some GOP senators argue will help people buy cheaper insurance.

“The lowest income have more access to health insurance at a more affordable price,” Sen. Tim Scott (R-S.C.) told reporters last week.

“It’s considerably more generous than the House,” Sen. Pat Toomey (R-Pa.) said Sunday on CBS News. Tax credits in the bill, he said, are “more oriented toward more low-income people, and those are the people who obviously need it.”

Outside healthcare experts, however, say the Senate bill would drastically undermine ObamaCare protections for low-income and older people.

While the House bill linked tax credits mainly to a person’s age, the Senate bill retains ObamaCare’s general structure of basing subsidies on age, income and local insurance costs.

However, it also phases out eligibility for the tax credits sooner and makes the credits smaller.

“Instead of just replacing [Affordable Care Act] tax credits, the Senate bill cuts them and cuts other financial assistance,” said Aviva Aron-Dine, a senior fellow and counselor with the Center on Budget and Policy Priorities.

“These changes lead to higher premiums and higher deductibles.”

Starting in 2020, the bill would scale back eligibility for tax credits to 350 percent of the federal poverty level, compared to 400 percent under ObamaCare.

That means an individual with an annual income of $41,580 would not be eligible for the tax credits. Under ObamaCare, the cutoff would be $47,550.

The Senate bill would also scale back how much the federal government spends on the subsidies by tying them to the value of the cheapest, least generous ObamaCare plans.

These plans only cover, on average, 58 percent of an enrollee’s costs, while the current structure is tied to plans that cover about 70 percent.

This means people could end up with smaller subsidies for plans that cover less with higher deductibles and copays, experts say.

“Nearly all consumers would face a choice: pay more in premiums to keep their coverage or try to keep their premiums stable by purchasing a plan with a higher deductible,” Aron-Dine said.

Republicans argue these changes will drive down premiums so people can afford insurance, one of their primary goals in reforming ObamaCare, while reining in healthcare costs and directing help to the most needy.

But the bill could also be damaging for low-income people in other ways, experts warn.

Lower-income people could face additional costs with the Senate bill’s elimination of ObamaCare’s cost-sharing subsidies in 2020. These payments reimburse insurers for giving discounted deductibles and copays to people with income below 250 percent of the poverty line.

Older people with moderate incomes would also be expected to pay more toward their healthcare subsidies under the bill compared to ObamaCare.

The Senate bill, like the House bill, also changes the cap on how much insurers can charge older people for insurance compared to younger people, from a 3 to 1 ratio to 5 to 1.  

Another critical part of the bill is its treatment of ObamaCare’s Medicaid expansion.

The Senate bill would phase out the federal expansion more slowly than the House bill, but it imposes deeper cuts on Medicaid in later years. 

A number of senators from states that expanded Medicaid under ObamaCare are undecided on the bill. Sen. Dean Heller (Nev.), considered the most vulnerable GOP senator up for reelection next year, is a no vote.

“It’s going to be very difficult to get me to a yes,” Heller said at a press conference last week.  “You have to protect Medicaid expansion states. That’s what I want.”

ObamaCare’s expansion of Medicaid allowed about 14 million additional low-income people to get healthcare insurance. Most of those people will be eligible for tax credits that would help them with the expansion’s phaseout, but it’s possible some of them could lose coverage.

Other GOP senators have sounded the alarm on the Medicaid changes, worrying about how it could impact the low-income people in their state.