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The Senate’s Obamacare repeal bill is coming Thursday. Here’s what we know.

“I haven’t seen it.”

Chip Somodevilla / Getty Images
Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

After weeks of secret negotiations, Senate Republicans are almost ready to release their plan to repeal and replace Obamacare. The bill text is supposed to come out Thursday.

The Senate’s internal deliberations have taken place almost entirely behind closed doors, shrouding the entire process in mystery. But the time has almost come for a bill to be made public. Leadership is still pushing for a vote by July 4, which could leave senators and the rest of the country with as little as one week to review such a major piece of legislation.

The Capitol is abuzz with rumor and speculation about what could be included, how millions of Americans who have benefitted from Obamacare would fare, and whether the plan that Senate Majority Leader Mitch McConnell (R-KY) settles on can get the 50 votes it needs to pass.

This is what we know — and what we don’t — for sure.

The bill will be released Thursday

In the next few days, we’ll know a lot more about what the Senate is proposing.

  • Senate Republicans are meeting on Thursday morning, at 9:30 am, to review a complete draft of the health care bill, according to senators and congressional aides.
  • The text is expected to be released publicly around that time, though it could be delayed until after the meeting.
  • The Congressional Budget Office is then expected to release its official analysis of what the bill would cost and how many people it would cover on Friday or Monday, Sen. John Cornyn (R-TX) told reporters.
  • Senate leadership is said to still be pushing for a vote by the July 4 recess, before senators leave town to go home for a week.

The Senate bill will resemble the House bill in many ways

Some Senate Republicans have played up the idea that their plan will differ significantly from the House bill that was projected to lead to 23 million fewer Americans having health insurance and an $830 billion cut to Medicaid. But, while it’s impossible to know exactly until we see the bill, the Senate plan will likely resemble the House legislation in several important ways:

  • It will eventually end the generous federal funding for Obamacare’s Medicaid expansion, which covered millions of lower-income Americans.
  • It will institute a federal spending cap on Medicaid, limiting funding for the entitlement program for the first time.
  • It will ratchet down the financial assistance for people to purchase private insurance, compared to Obamacare.
  • It will give states more leeway to waive Obamacare’s insurance regulations.

A few touchy issues still divide Senate Republicans

Nonetheless, the Senate is expected to make some changes to the House’s plan, trying to strike a balance between the more centrist and more conservative wings of the GOP conference on Medicaid and insurance regulations, as well as always contentious issues of abortion and Planned Parenthood.

Nobody is sure how those issues will be resolved, or if they do, they aren’t saying. Sen. Rand Paul, one of the Republicans most bent on rolling back as much of Obamacare as possible, ticked through a whole list of problems he has with the emerging plan. He opposes a stabilization fund for insurance companies, included in the House bill, which the Senate’s bill is also likely to include.

I asked him if, based on what he does know, he could support the Senate bill.

“I haven’t seen it. We’re gonna wait to see it tomorrow,” he said. “We’ll be reading it tomorrow morning.”

There is also some doubt of whether certain provisions comply with the complex Senate rules Republicans are using to pass the bill without any Democratic votes.

Here are some of the outstanding issues:

  • Will they defund Planned Parenthood?
  • Will they prohibit the bill’s financial aid from paying for health plans that cover abortion?
  • Over how many years will they phase down the generous federal funding for Medicaid expansion?
  • How much will they allow the Medicaid spending caps to grow in the future?
  • Which of Obamacare’s insurance regulations will they allow states to waive? The prohibition on plans charging sick people more than healthy people? The requirement plans to cover certain essential health benefits? The limit on how much more insurers can charge older people than younger people?

A lot of Republicans have big problems with the emerging plan

McConnell is working with a very thin margin for error: He can lose only two of the 52 Senate Republicans and still have the bare majority he needs.

The moderate senators are still pushing for a more gradual phaseout of Medicaid expansion and less harsh spending caps. Conservatives want more of Obamacare’s regulations rolled back and they’re worried about the abortion-related provisions. A few senators seem mostly upset with the secretive and truncated process being used to pass the bill, with minimal public input, though it’s doubtful that they’d really vote against the plan over those concerns.

“I need the information to convince me that we’ll be in a better place,” Sen. Ron Johnson (R-WI) said Thursday.

Other swing votes were largely avoiding questions the day before the release, saying they have to wait to see the text.

“Believe me, I’m even more eager than you are to see the bill, so I can answer these questions,” Sen. Susan Collins (R-ME) said.

McConnell might try to cut some last-minute deals to win over those holdout votes. Sens. Rob Portman (R-OH) and Shelley Moore Capito (R-WV), the two senators most concerned about Medicaid, have been pushing an additional $45 billion in funding for the opioid crisis.

Collins opposes defunding Planned Parenthood, though she has said only that she would want an opportunity to vote to strip out the defunding provision — not that she would oppose the final bill if that vote failed.

The majority leader could still find a path to passage. But it’s going to be tough. Many senators have laid out pretty difficult demands. Paul, for example, said that he’d oppose any funding being funneled to insurance companies through that stabilization fund — a provision that seems almost certain to be in the bill.

Though he too has left himself an out, as the world waits for a final bill.

“We haven’t seen it yet,” Paul said. “Putting $70 billion, $80 billion, in a stabilization fund is an entitlement program for insurance companies, and I’m not for that.”