Senate Obamacare Repeal Has Lots of New Provisions

This story has been updated to reflect new information from the text of the bill.

New details are emerging about the breadth of the Senate’s attempt to force President Obama to veto a large-scale takedown of the Affordable Care Act.

Senate Republicans released their additions to a House reconciliation package Wednesday. Previously unreported provisions include a measure to provide states with a two-year block grant to combat mental health issues, which specifically targets opioid abuse.

It would also restore a program cut by Obamacare to make payments to hospitals that serve a disproportionate number of low-income patients, known as Medicaid DSH. The measure would repeal three initiatives designed to mitigate risk for health insurance companies entering into the new marketplace — Obamacare reinsurance program, risk corridors, and risk adjustment programs.

Like the House bill, the legislation would terminate the Prevention and Public Health Fund.

Any on-budget savings would be transferred to a Medicare trust fund.

Senate Majority Leader Mitch McConnell (R-Ky.) filed an amendment Tuesday night largely aimed at bringing the House bill into alignment with the complex Senate rules that govern budget reconciliation, the procedure that allows the majority party to bypass a filibuster.

The amendment included one new provision not found in the House text — a provision to collect overpayments of ACA insurance subsidies.

It also fixed concerns that the Senate parliamentarian raised about language in the House version to eliminate the ACA’s mandates, which impose penalties on individuals and employers who do not buy insurance for themselves or offer it to their employees. Senate Republicans have overcome that hurdle by lowering the penalties associated with both mandates to $0.

A few of the major repeal elements wouldn’t go into effect until 2018, a bid to allow policymakers and the next president a full year to build a healthcare infrastructure to replace the Obamacare system this bill would dismantle. Those provisions include repeals of the state Medicaid expansion and of the law’s insurance subsidies. Also starting in 2018, the Department of Health and Human Services would be prohibited from running the federal healthcare exchanges, the online healthcare marketplaces Obamacare created.

Senate leaders will target almost all of the taxes associated with the law. The House’s more limited repeal effort targeted only two Obamacare taxes: one on medical devices and another on high-cost employer sponsored health coverage, known as the “Cadillac” tax. In a new twist, the Cadillac tax repeal wouldn’t go into effect until 2025.

Like the House bill, the Senate’s version would strip Planned Parenthood of its federal funding and redirect that money to community health centers. There is a technical tweak: Tuesday’s substitute amendment specifically targeted the group’s mandatory federal funding, whereas the House bill had simply prohibited federal money from flowing to the organization.

Democrats are already hitting back. Sen. Patty Murray (D-Wash.) introduced an amendment to strike the Planned Parenthood provision from the reconciliation bill.

McConnell started the 20-hour clock on the special budget procedure Tuesday night, and said earlier that day he hopes to complete consideration of the bill Thursday. Senators could be in for a rapid-fire series of amendment votes, known as “vote-a-rama,” Thursday night. Aides say the voting process could go quickly, however, as Senate Democrats see much of this drama as a show vote with no meaning.

Though the Obamacare repeal will be met with a certain White House veto, the procedure is appealing because it allows legislation to move through the Senate solely at the behest of the majority party. For Republicans, it represents both the fulfillment of a campaign promise – to force Obama to veto a repeal of his signature domestic policy achievement – and proof that with a Republican president the party has a viable legislative path to dismantle the law.