As they rush toward an expected vote this week, Senate Republicans introduced a revised version of their legislation to repeal and replace Obamacare.
The revised draft resembles the original in its major provisions. It would:
- Keep most of Obamacare’s private insurance reforms, while reducing the financial assistance available to people who purchase their own coverage and giving states more leeway to scale back the law’s regulations;
- Eventually end the generous federal funding for Obamacare’s Medicaid expansion while overhauling the entire Medicaid program’s financing;
- Cut Obamacare’s taxes on the wealthy and health care industry.
But it includes a couple of important changes. Most notably, it adds a penalty for people who go without insurance, to replace Obamacare’s individual mandate. People with a lapse in coverage would have to wait six months for their benefits to start under the new Senate bill. That’s meant to encourage healthy people to buy insurance to avoid a “death spiral” — when healthy people opt out of purchasing insurance, leaving insurers with only sicker, more expensive patients in need of coverage.
The legislation still faces a difficult political path, as a half dozen conservative and moderate senators have already stated their deep concerns with the plan. It’s not yet clear that any of the revisions will substantially change that calculus. Senate Majority Leader Mitch McConnell needs 50 of the 52 Senate Republicans to back the bill.