WASHINGTON (Reuters Breakingviews) - The U.S. Senate healthcare bill lacks "heart" to pass in its current form. President Donald Trump wanted more of that and a less "mean" rollback of Obamacare. Yet the Senate spared only 1 million of the 23 million set to lose health coverage under the House plan, according to Congressional Budget Office figures. On that showing, even a Republican-only deal will need surgery.
The CBO on Monday scored the Senate bill, released on Thursday after weeks of secrecy. It would reduce the U.S. deficit by some $200 billion more over a decade than the plan that passed the House in May, while the projected insurance-premium hikes are steep rather than stratospheric. But they would still be painful for lower and middle-income individuals. For example, a 64-year-old making $26,500 a year would see an increase of more than 280 percent to $6,500 a year by 2026, the CBO said.
Before the CBO's score came out, the White House sought to further undermine the office by saying it has a poor track record in healthcare projections, having overstated the early take-up of coverage under President Barack Obama's Affordable Care Act. Yet the CBO is broadly nonpartisan and, importantly, it's consistent in how it evaluates legislation, so its analysis carries weight.
Four conservative Republicans have already said they can't support the current bill, largely because it doesn’t go far enough in repealing Obamacare. Senator Ron Johnson of Wisconsin, who wrote a commentary on Monday opposing the plan, said the bill would fail if the chamber voted to proceed on Tuesday.
Moderates are also unhappy. Roughly in line with the House bill, under the Senate version Washington would spend around $800 billion less over 10 years on Medicaid – healthcare for lower-income Americans – than under current law, according to the CBO, with 15 million fewer enrolled in the program. Senator Dean Heller of Nevada, as one example, opposes ending the expansion of Medicaid under Obamacare, which his state and dozens of others adopted.
Republicans have pledged for years that they would repeal Obamacare but they have a slim 52-member majority in the 100-member Senate. Changes that appease conservatives might alienate centrists, and vice versa. The GOP leadership will need both heart and head to pass any form of repeal.
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- The U.S. healthcare plan put forward by Senate Republicans, known as the Better Care Reconciliation Act, would leave an additional 22 million uninsured by 2026 compared with current law, the Congressional Budget Office said on June 26. The same day, the Senate released a slightly revised version of the bill that was first made public on June 22.
- The House of Representatives passed its Obamacare replacement, known as the American Health Care Act, in May. The CBO review concluded 23 million additional people would lose coverage by 2026 under that plan.
- The BCRA would reduce the federal deficit by $321 billion over a decade, the CBO reckons, with key elements including a $772 billion decrease from currently projected expenditures on Medicaid offset by $541 billion of lost revenue, partly thanks to ending higher taxes on high-income individuals enacted under Obamacare, more formally known as the Affordable Care Act. The earlier house bill, named the American Health Care Act, cut the 10-year deficit by $119 billion.
- The CBO said healthcare insurance premiums for 64-year-olds making $26,500 a year would increase almost fourfold to $6,500 by 2026. The AHCA could have seen the figure go at least twice as high as under the Senate plan.
- Many of the changes proposed by the House have been carried over into the Senate bill, although there are adjustments in some areas. Several conservative and moderate Republican senators have expressed concerns about the bill. It needs a majority to pass in the 100-member Senate. Republicans have 52 seats. If there is a tie, Vice President Mike Pence can vote.
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