Senate Republicans on Thursday unveiled a sweeping measure to roll back the Affordable Care Act, dramatically reducing government spending and in a way that could leave millions more Americans without health insurance.
The plan, released by Senate Majority Leader Mitch McConnell and his team after working on it largely behind closed doors in recent weeks, would hit California particularly hard, in large part because the Senate bill proposes deep long-term cuts to Medicaid, called Medi-Cal in this state. But proponents say the bill would save taxpayers in California and elsewhere billions of dollars in costs by taming the runaway benefits of Obamacare.
About 14 million Californians — more than a third of the Golden State’s residents — are covered under the health care program for low-income and disabled residents, including about four million who were added since 2014 through a provision of the Affordable Care Act that allowed adults without dependent children to enroll.
Anthony Wright, executive director of Health Access California, said the bill’s “draconian cuts” to Medicaid would be widely felt, affecting not only “half of our children, and two-thirds of our seniors in nursing homes, but the health system on which we all rely.”
Wright said the Senate bill would spike premiums and deductibles for many middle-class families who are covered by plans under Covered California, the state’s health care insurance exchange established under the Affordable Care Act.
The bill came under immediate attack from conservative and centrist Republican senators as well as health industry officials, casting the bill’s viability into doubt even as GOP leaders plan to bring it to a final vote next week.
No Republican senators definitively said they would vote against the bill, which needs at least 50 of 52 Republicans would need to vote for it because no Democrats are expected to support the bill Instead, several GOP senators — including Ted Cruz of Texas, Rand Paul of Kentucky, Ron Johnson of Wisconsin and Mike Lee of Utah — focused their attention on the provisions that would need to be changed to earn their vote.
The Senate bill is similar to the House health care bill that passed last month. Like the House bill, the Senate version would repeal Obamacare’s individual mandate and severely cut back on federal support of Medicaid, as well as eliminate Obamacare’s taxes on the wealthy and insurers. Both the Senate and House plans would keep Obamacare’s subsidies to help people pay for individual coverage — but they wouldn’t be as generous as those under the Affordable Care Act.
California has long championed Obamacare and its success in slicing the number of uninsured Californians by more than one-half. And many problems that have popped up on other state health insurance exchanges around the country — soaring premiums and health insurers dropping out of the marketplace — just haven’t happened here.
Peter Lee, executive director of Covered California, underscored in a tweet Thursday the bleak future that he believes lies ahead for many of the state’s residents.
“While it appears that the Senate bill largely adopts the marketplace and subsidy structure of the Affordable Care Act, in many ways we could be returning to the days when consumers who thought they were covered found the rug pulled out from underneath them when they tried to get health care,” Lee wrote.
Jonathan Greer, a spokesman at the Golden Gate Association of Health Underwriters, agreed, saying fewer middle-income Californians would be eligible for health insurance subsidies since the bill lowers the maximum income level for receiving a subsidy.
“In a high-cost state like California, that’s a big problem,” Greer said. For example, he said a family of three earning $75,000 a year is currently eligible for subsidies but wouldn’t be under the new bill. In the Bay Area, an unsubsidized plan offering benefits such as low-cost prescription drugs can cost more than $1,000 per month, he said.
Greer pointed to a bit of good news for lower-income Californians in the Senate’s version: Unlike the House bill that proposed age-based subsidies, the Senate bill retains Obamacare’s income-based premium subsidies that millions rely on to make health insurance more affordable.
But it’s the dramatic cuts in federal funding to Medicaid that would hit states the hardest and force them to make deep cuts in the program.
That hit home with Gov. Jerry Brown, who pulled no punches Thursday in his assessment of the Senate plan.
“Trumpcare 2.0 has the same stench – and effect – as the bill House Republicans and the White House slapped together last month: Millions will lose health care coverage, while millionaires profit,’’ Brown said in a statement. “The American people deserve better.”
Former President Barack Obama, who has eschewed speaking up on political issues since leaving office in January, wrote Thursday on his Facebook page that the Senate proposal showed a “fundamental meanness” that would hurt the elderly and sick.
“The Senate bill, unveiled today, is not a health care bill,” Obama wrote. “It’s a massive transfer of wealth from middle-class and poor families to the richest people in America. It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else.”
Trump tweeted his support of the bill Thursday.
“I am very supportive of the Senate #HealthcareBill. Look forward to making it really special! Remember, ObamaCare is dead,” he wrote.
Last month in the Rose Garden, Trump praised the House after it passed its own health care replacement bill, calling it “a great plan.” But last week, Trump changed his tune, according to Republican senators, who said Trump told them that the House bill was “mean” and he hoped the Senate would improve the legislation.
Some Bay Area health policy experts were supportive of the Senate plan. They included Lanhee Chen, a fellow at Stanford’s Hoover Institution who has long supported replacing Obamacare. He called the Senate bill “an improvement” over the House version.
“For states that want to experiment with their own health solutions, the bill will provide greater flexibility and an opportunity to generate reforms that work best for their own citizens,’’ said Chen, a former top adviser to GOP presidential candidates Mitt Romney and Marco Rubio.
Fellow Bay Area GOP health care adviser Sally Pipes was not as pleased with the Senate’s proposal.
“It is worse than I imagined — I think it will keep Obamacare in place forever if it passes the Senate,” said Pipes, the president and CEO of the San Francisco-based Pacific Research Institute, a nonprofit that promotes limited government.
For example, Pipes noted that the Senate bill keeps the Medicaid expansion in place for three more years and then a three-year phaseout, which she said “means the expansion will never end.”
The proposed bill is the first concrete display of what the Senate GOP conference will have to work with to overhaul the nation’s health care system. But there’s not much time: With McConnell pushing for a vote next week, senators have just a handful of days to decide whether to support or vote against the bill.
By keeping the details tightly under wraps until Thursday, McConnell and his colleagues seemed to be hoping they could win over their colleagues, while keeping the horse-trading out of the public spotlight. In the process, however, their secrecy angered Democrats while aggravating a number of Republicans, too.
The vote required for the bill’s passage will be tight: McConnell can afford to lose only two Republican votes.
The Associated Press and the Washington Post contributed to this report.
