5 things to know as Senate Republicans unveil their health care bill

Morning Call (Allentown, PA)

June 22--Senate Republican leaders are expected to unveil a draft of their health care legislation today after a closed-door process that even some Republican lawmakers haven't been privy to.

As they await a briefing on the legislation, here's a refresher on the health care discussions that have been unfolding on Capitol Hill and what Pennsylvanians have at stake.

Pennsylvania's Pat Toomey was among those crafting the bill

Toomey is among 13 Republican senators who were most closely involved in the process since the House passed its own legislation in May.

He and Ohio Sen. Rob Portman were tasked with shaping the bill's approach to Medicaid, the health insurance program for low-income, elderly and disabled individuals that was expanded under Obamacare.

How does the Senate handle Medicaid expansion?

More than 700,000 Pennsylvanians became eligible for Medicaid due to the Affordable Care Act, or Obamacare, which allowed states to expand coverage to non-elderly individuals earning above the federal poverty level. The federal government picked up the tab for the new enrollees, at a rate that will drop to 90 percent by 2020.

Under the House bill, the extra federal funding for those currently enrolled under Medicaid expansion would continue as long as they remain in the program. New expansion enrollees after 2020 would be covered at the same rate as traditional Medicaid, or about 57 percent in Pennsylvania, leaving states to decide whether to fill that financial gap or to reduce eligibility or benefits.

The Senate bill is expected to allow states to continue that expansion, something that Toomey has said he's open to. But the extra funding likely would decrease over a longer time period than what the House proposed.

Senate expected to more deeply limit future Medicaid payments

The House bill also capped how much states receive for each individual enrolled in Medicaid. Instead of guaranteeing payments to cover the cost of medical care used by Medicaid enrollees, each state would get a set amount of money each year to pay for Medicaid care.

The federal share would increase based on enrollment and on annual changes to the medical CPI, or consumer price index.

Toomey has sought to further limit the program's future growth, which he says is unsustainable. He wants to link it to the CPI-U, arguing that such an annual increase would be closer to the economy's growth rate.

The Senate bill is expected to include "an eventual transition" to that lower growth rate, according to Toomey's office.

That change would put pressure on states as costs rise. State officials would have to to decide whether to fill that financial gap or to reduce eligibility or benefits.

What about premium subsidies? And the taxes?

Another concern that some raised about the House bill, including Republican U.S. Rep. Charlie Dent, was how it would change health care subsidies. The House bill linked insurance subsidies to a person's age, while the Senate bill is expected to base premium assistance on income.

Also at stake are the taxes enacted under Obamacare, including a levy on medical devices that was temporarily halted in 2015.

Casey, Dems are staunchly opposed

Democrats, including U.S. Sen. Bob Casey of Pennsylvania, have vocally pushed back against GOP efforts to repeal and replace Obamacare. They've sought to slow down legislative activity this week, and a trio of senators live-streamed a cab ride to the Congressional Budget Office, where they sought to retrieve a copy of the bill.

Casey quipped this week about trying to find the room where the GOP was meeting on the bill, and urged liberal activists to contact their senators to show their opposition.

lolson@mcall.com

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