Image via Getty. Smile via McConnell’s empty soul.

After weeks of closed-door hearings, Senate Republican leaders have finally released a draft of their health care bill. The bill, tentatively called the “Better Care Reconciliation Act of 2017,” eliminates the individual mandate requiring Americans to have insurance, makes deep cuts to Medicaid, and would phase out the Obamacare expansion of Medicaid beginning in 2020.

In addition, the bill provides tax cuts for the wealthy, particularly those who earn over $200,000, and for insurance companies. It also allows insurers more leeway to determine what to cover, jettisoning the Obamacare requirement that insurance companies cover a certain percentage of services. Perhaps most importantly, the Senate bill also eliminates the essential health benefits mandated by Obamacare, which include maternity care, newborn care, mental health services, and prescription drug coverage.

The Senate bill also focuses on abortion coverage, targeting providers directly by placing more restrictions on federal subsidies, particularly Medicaid waivers (there are exceptions for rape and incest, as well as cases “where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death”). This is essentially a plan to defund Planned Parenthood. In addition, it restricts federal subsidies for being used on “any health plan that includes coverage for abortions” with, again, similar exceptions.

It departs from the House bill too by making subsidies income specific rather than age-specific as the House did. It also jettisons a key part the House bill, namely the Senate version does not allow states to remove themselves from Obamacare mandates about patients with pre-existing conditions (remember Paul Ryan’s state-run, high-risk pools solution?). Those elements, as well as the longer timeline for Medicaid shrink, might prove to be the most controversial among Republicans. The Washington Post reports that they were added to “soften” the bill and help Mitch McConnell “win over a half dozen or so moderates who remain skeptical but whose votes are crucial to overall passage.” Still, there are deep cuts to Medicaid here and, as Democrats have already pointed out, they are more extensive than even the House bill.

Advertisement

Advertisement

It’s an unnecessary kindness to call this bill “softer” than the House’s, which even the heartless Donald Trump called “mean.” This bill is an unmitigated disaster for women’s health and for poor and working class people. During a press conference immediately following the bill’s release, Nancy Pelosi said that this is a “tax bill disguised as a health care bill” adding that she was more concerned with the “substance” of the bill rather “than [the GOP’s] process right now.”

It’s unclear whether or not McConnell has the fifty votes needed to pass the bill. A handful of Republicans have already expressed discomfort over the bill but that may turn out to be performative. McConell has promised 20 hours of debate on the bill, including a “vote-a-rama” where Senators will be allowed to propose and vote on an endless number of amendments to the bill. It’s going to be a mess. If the bill passes, it will still have to go to reconciliation with the House bill and then onto the president’s desk.