Some Texans applaud, some offer tepid support, while others voice disgust.

Senate Republicans’ health offering receives a mixed reception in Texas

The U.S. Senate’s health care plan garnered mixed reviews in Texas on Thursday. Some applauded its sweep, others offered tepid support, and still others voiced outright disgust as they accused the bill of balancing tax cuts on the backs of the state’s most vulnerable.

The 142-page “discussion draft,” titled the Better Care Reconciliation Act of 2017 and authored in secret by Senate Republicans, in essence repeats much of the U.S. House bill that narrowly passed last month.

Senate leadership has said their version could be voted on next week.

The bill seeking to unspool the current law known as Obamacare would do away with the mandate that most every American have health insurance as well as steeply curtailing Medicaid spending. The proposal also returns to states the power to limit some insurance provisions now in place, including mandatory maternity coverage and the inclusion of behavioralhealth benefits.

While those major provisions closely mirror ones offered in the House version, the similarities did little to temper gut reactions Thursday — at times even within the same political party.

“I give it an F,” said Chip Roy, senior adviser

of the Texas Public Policy Foundation, a conservative think tank in Austin. He called it a “tweaking around the edges” of the Affordable Care Act, which Republicans like him have long vowed to dismantle in its entirety.

Roy, former chief of staff for Sen. Ted Cruz, R-Texas, said he was disheartened that the Senate version “double-downed on the flawed infrastructure of Obamacare.”

The Senate bill takes sharp aim at Medicaid, ending the expansion in 31 states that was a hallmark of Obamacare. But even in non-expansion states like Texas, deep cuts are proposed as the measure would cap future dollars per enrolleebased on past spending.

The Medicaid cuts under the Senate bill ultimately would be deeper than what was proposed in the House. A previous analysis of the House plan predicted Texas could lose $1.5 billion per year over the next decade. If the state failed to make up that difference, it is widely expected that services would be curtailed and fewer people would be eligible.

“For Texas this will be even worse than the House bill,” said Elena Marks, president and CEO of Houston’s Episcopal Health Foundation.

Reached by phone in Boston Thursday as she attended the Grantmakers in Health convention for health care philanthropists, Marks said the mood turned somber as the bill was made public.

Texas already is tied with Alabama for having the nation’s strictest threshold for qualifying for Medicaid, and Marks worries the state’s neediest cannot shoulder more cuts. More than 4 million Texans, the vast majority of them poor children, currently receive Medicaid benefits.

A Kaiser Family Foundation study found that more than half of the births in Texas were financed by Medicaid.

Others in Texas who receive Medicaid are the elderly, people with severe disabilities and pregnant women.

Michael Morrisey, a health economist and professor at the Texas A&M School of Public Health, was more generous in his appraisal. With the caveat that he had not studied the bill in depth, he said he found parts to like, especially measures giving states more latitude to customize regulations and coverage standards.

“I think that is a very good thing,” he said, adding that he never favored the Affordable Care Act’s one-size-fits-all mandates and provisions.

One provision in the Senate bill would allow states to receive block grants for some health care costs. States also could determine the percentage of revenue an insurance company could use for overhead costs. The ACA mandates that no more than 20 percent could go to non-coverage costs.

Morrisey also liked that the Senate measure would reconfigure how federal subsidies are given to help pay for insurance, moving away from the flat, agebased calculation floated by the House to one that is based also on income, more akin to the ACA.

“You want it to be needsbased,” he said.

The bill would have a stricter income threshold to qualify for tax credits. Like the House bill, older Americans could be charged five times more than the young compared to the current three-to-one ratio.

Still, younger and healthier people could benefit more from the Senate plan than the current law and in states like Texas, which leads the nation in the so-called coverage gap, people living under the poverty line would be eligible for help where they were not under the ACA.

Marks remained unmoved in her criticism.

“It’s not all that heroic,” she said.

She also complained the Senate plan would eliminate help to the poor to offset high deductibles and co-pays.

“The bill is terrible for Texas,” added Stacey Pogue, a senior health policy analyst at the Center for Public Policy Priorities. “It’s a tax-cut bill. The way it pays for tax cuts to insurance companies, pharmaceutical companies and the wealthiest Americans is by gutting health care for those with low and moderate incomes.”

Under the Senate plan, Obamacare taxes on overthe-counter and prescription medication, medical

devices and the tanning industry all would be repealed. The bill also would repeal the tax on investments, which had targeted the wealthiest Americans, as a way to help pay for Medicaid expansion.

The plan also would eliminate funding for Planned Parent hood foray ear.

Morrisey remained skeptical of the removal of the individual and employer mandate without something to encourage healthy people to sign up for insurance to stabilize the risk pool.

The A CA levied a penalty for those who did without insurance. The House plan would do away with that measure but impose a 30 percent surcharge to regain coverage once lapsed. The Senate plans offered no incentive to remain covered.

The measure also split the state’s two U.S. senators, both of whom were part of the committee overseeing the bill. Cruz came out against the bill Thursday. Fellow Sen. John Cornyn offered a more triumphant take.

”The time to close the book on Obamacare is now,” Cornyn said in a statement. “Our plan will help deliver access to better care at a price the American people can afford.”

Rep. Kevin Brady, R-The Wood lands, praised his Senate counterparts and their reworking of the House bill he had helped construct.

“I’m pleased to see the Senate moving forward with legislation that brings us closer to repealing and replacing Obamacare,” he said in a statement.