Watching the Senate
Despite earlier claims that the Senate was going to take their time before any legislation gets written, the fact is that they cannot wait much longer before they have to move onto other issues. The consensus is now that bill will be written and brought to the CBO for scoring - essentially in secret - and will only be brought to the floor when it's time to vote.
What will this bill going to look like? There's much speculation but little substance - yet enough has been discussed and presented to paint a troubling picture..
Per-capita caps. One thing that has powered through the legislative fray is the goal to transform Medicaid funding into a per-capita system. This would be devastating, cutting billions from Medicaid budgets and forcing states into impossible decisions on who and how much to cut, and how much less providers would get paid. The Trump budget touted caps as a way to save billions - a clear sign that it's an essential element of the legislative agenda It's the one piece of the puzzle that everyone in the GOP agrees on.
Medicaid expansion. One of the biggest sticking points is how quickly should the Medicaid expansion end? Many Senators want a slower ramp-down than the House timeframe of no new enrolless by 2020. But ending expansion is where most of the touted Medicaid savings comes, so there's a real conflict between the conservative factions and expansion-state senators who don't want that money going away.
State waivers.The House bill would have let states use waivers to circumvent two major elements of the ACA, like essential health benefits and coverage for pre-existing conditions. Seeing what happened at town halls, senators realized pre-existing waivers are a hot potato, and appear to have backed away from removing them.
But the Senate has a heavy lift. Senate Majority Leader Mitch McConnell himself expressed doubt about being able to gather 50 votes for the plan. With 52 Senate seats controlled by the GOP, it would only take 3 defections to defeat the bill.
House Republican health bill would effectively end ACA Medicaid expansion
- Center on Budget and Policy Priorities