Wealthy benefit most under Senate draft bill

But health care costs would rise for poor

WASHINGTON — Senate Republicans on Thursday unveiled a draft bill to roll back the Affordable Care Act, including a drastic reduction in federal health care spending that threatens to leave millions more Americans uninsured, drive up costs for poor consumers and further destabilize the nation’s health insurance markets.

The legislative outline, which Senate Majority Leader Mitch McConnell’s team wrote largely behind closed doors, hews closely to the Obamacare repeal bill passed last month by House Republicans, though it includes important differences. The House version was first celebrated by President Donald Trump in a White House Rose Garden ceremony, though he later criticized the bill as “mean.”

Like the House bill, the Senate plan would eliminate hundreds of billions of dollars in taxes over the next decade, with large benefits for the wealthiest Americans. And like the House bill, it would pay for those cuts by dramatically reduc-

ing federal money for Medicaid, likely forcing states to make deep cuts in their health care programs for the poor. Trump vowed in his campaign not to reduce Medicaid.

The Senate bill preserves premium subsidies that help some lowincome buyers purchase insurance, but it would scale them back.

The reductions in federal spending for health care, which would be the largest rollback of the federal health safety net in history, drew sharp criticism from patient groups, doctors and some insurers.

McConnell, R-Ky., hopes to call a vote on the measure next week, all but daring Republican holdouts to oppose it and prolong what has been a politically painful process to fulfill their promise to do away with Obamacare.

It’s unclear if McConnell has the 50 votes he needs for passage, as almost a dozen GOP senators voiced reservations. Moderates thought the bill was too harsh, while conservatives wanted a faster rollback of Obamacare.

A few hours after McConnell released the text to a closed-door meeting of Senate Republicans, four conservatives — Sens. Ted Cruz of Texas, Mike Lee of Utah, Ron Johnson of Wisconsin and Rand Paul of Kentucky — announced their opposition to the draft.

Among the party’s centrists, Nevada Sen. Dean Heller said he had “serious concerns,” citing the Medicaid cuts. Sen. Shelley Moore Capito of West Virginia said she was concerned about the impact on treatment for opioid addiction. Sen. Bill Cassidy of Louisiana said he is not ready to support the measure.

After spending seven years promising to repeal Obamacare, Republicans are under intense pressure to deliver. But the law has grown popular, and many more Americans are insured, making the new safety net difficult to unravel.

Trump said Wednesday night, during a campaign rally in Cedar Rapids, Iowa, that he had told senators to “add some money to it” to produce a health care bill with “heart.” Asked Thursday if the Senate draft met that standard, Trump suggested some changes were needed. He tweeted Thursday: “I am very supportive of the Senate #HealthcareBill. Look forward to making it really special! Remember, ObamaCare is dead.”

But Senate Minority Leader Chuck Schumer, D-N.Y., said that by slashing taxes on the wealthy and cutting health care for the poor, “the Senate version of Trumpcare is even meaner than the House bill.”

Obama picked up on Trump’s theme, writing Thursday on Facebook, “small tweaks over the course of the next couple weeks ... cannot change the fundamental meanness at the core of this legislation.”

The legislation also drew condemnation from the nation’s health care system and consumer advocates. Capitol Police said they arrested 43 people protesting Medicaid cuts in a Senate office building.

The Senate bill eliminates the law’s mandate that every American carry insurance. Unlike the House bill, it includes no incentive or penalty to ensure younger, healthier people get coverage. It also puts new restrictions on federal funding for Planned Parenthood, barring organizations that perform abortions from receiving Medicaid funding.