In a 55-45 defeat the GOP rejected Senator Paul Rand’s amendment for repeal only (Obamacare), making it the second healthcare plan proposed by amendment to the Senate floor that was turned down after BCRA was voted down on Tuesday. The amendment offered up by Senator Paul Rand of Kentucky proposed repealing Obamacare and providing the Senators a cap of a 2 year window of opportunity to come up with a better healthcare plan.
The amendment would have stripped away much of the ACA such as Medicaid expansions and insurance subsidies, but would have left the ACA’s insurance market reforms in place. However, one of the main objections to moderates in the GOP was that the amendment was projected to have left an additional 18 million people uninsured in 2018, and those numbers could reach as much as 32 million by 2026, according to the Congressional Budget Office’s (CBO) report. The report also indicated that insurance premiums purchased by individuals through the private insurance market or marketplaces would increase by as much as 50% by the year 2026 without the Medicaid expansion or subsidies of the ACA.
For GOP Senators Lisa Murkowski (Alaska), John McCain (Arizona), Susan Collins (Maine), Dean Heller (Nevada), Rob Portman (Ohio), Lamar Alexander (Tennessee), and Shelley Moore Capito (W. Virginia) the uncertainty of what a replacement bill would look like and the CBO’s report was enough for them to go against the President’s pressure on them to repeal Obamacare.
GOP Senate Majority Leader Mitch McConnell wasn’t deterred at all by the latest GOP loss. McConnell said that even though the proposal had failed he was pleased that it provided the vehicle to present “a number of important healthcare reform ideas developed by our members.” While McConnell may not be deterred he did say that getting a straight repeal, or repeal and replace bill which requires 50 yes votes through the Senate “certainly won’t be easy.”
The Majority Leader went on to say, “We’ll consider many different proposals throughout this process from senators on both sides of the aisle. Ultimately, we want to get legislation, to finally end the failed Obamacare status quo, through Congress and to the president’s desk for his signature.”
The next procedural move the GOP may take on Thursday will be to have at least a day, more likely two or three, of what some media pundits have called “voteOrama” where it is expected that numerous (at least dozens) amendment proposals will be presented and debated on the Senate floor.
It’s being suggested on both sides of the aisle that should the GOP “voteOrama” fail to produce an amendment for a vote that the next step may be try to pass what is called a “skinny repeal,” of Obamacare.
What Is A “Skinny Repeal”?
A “skinny repeal” of Obamacare would likely be a very narrow set of provisions that at least 50 Senators of the GOP can agree on, which would then give them a bill that they would then be able to take to a conference with House Republicans.
The House Republicans had passed a bill which they knew would not pass the Senate, but was done more as a procedural maneuver in order to get it to the Senate floor where new legislation could be crafted.
At this point it’s not known what the “skinny repeal” will entail, but it’s speculated that it will contain language that’ll focus on repealing a few of the most unpopular parts of the Obamacare mandates, such as; the mandate that individuals must purchase healthcare insurance, the large employer mandate to provide employees with the ACA minimum requirement health insurance coverage, and an excise tax on medical devices.
Another unknown is whether House Republicans would see a “skinny repeal” as an option in order to get a bill on the President’s desk for his signature. President Trump has repeatedly said we (the GOP) must repeal the disaster of Obamacare and that he is waiting with pen in hand for Republican’s to fulfill their campaign promise to repeal Obamacare.
What is known is that there doesn’t appear to be any signs of Democrats coming to the table to work with Republicans or helping to tip the scales. To date the Democrats have yet to participate in any way during the healthcare debate other than to cast their no votes from what President Trump calls the “obstructionist” Party. As yet Democrats have remained united in voting no on every GOP healthcare initiative and have offered no input or ideas in the debates on the Senate floor during the healthcare overhaul debates. This means that once again Republicans will need at least 50 of their 52 GOP votes and Vice President Mike Pence’s tiebreaking vote to pass a bill.
How Would A “Skinny Repeal” Affect You Tax Wise?
So if a “skinny repeal” is passed what would that do for you? If you are currently insured, not much at all is the sad and simple answer. The majority of the ACA taxes would remain in place, meaning; taxpayer paid Medicaid expansion taxes, taxes on insurance companies, taxes on pharmaceutical companies and the private and business sector taxes that include investment income, higher earnings, and the Cadillac tax on high-cost employer-provided health insurance plans and tanning beds would all remain.
A “skinny repeal” is expected to include repealing the medical device tax; this is a 2.3% excise tax on medical devices such as artificial hips, pacemakers, and other medical devices subject to this tax.
Would You Have To Pay The ACA Tax Penalty If You’re Uninsured?
No, it’s likely that under a “skinny repeal” the ACA mandate to purchase healthcare coverage would be repealed. So if you didn’t have coverage or you had a lapse in health insurance coverage you won’t have to pay a tax penalty.
Will Insurance Premiums Go Up?
If you do not have insurance through your employer or aren’t on Medicaid or another government sponsored plan the CBO previously estimated that individual’s premiums could increase 20% without the ACA mandate requiring everyone to purchase health insurance. The CBO estimates this would occur because younger and healthier people would be able to opt out of purchasing health insurance. With less people purchasing insurance, especially the young and healthy who offset the cost of older and sicker insured people, the CBO estimates premiums would rise.
Will You Get Help Paying For Higher Premiums?
For people who are already receiving subsidies to help pay for their healthcare insurance (people earning up to 400% of the poverty line) the answer is yes. The federal government (taxpayers) would have to increase the amount of help you receive to pay for the increase in premium costs.
However, for the people who earn more than 400% of poverty line, i.e. qualifying limit of $84,650 for a family of 3, you won’t receive any assistance or tax credit to help pay for the possible increase in your monthly premiums.
Will You Still Get Help Paying Deductibles & Co-Pays?
For the time being, if you are earning up to 250% of the poverty line you will still receive help from the government (taxpayers) with your out-of-pocket expenses. But it must be noted that President Trump has a pending lawsuit (which he temporarily suspended) against the government to stop paying for these (alleged unlawful) subsidies. So, for the time being the answer is yes, but it’s not known if Trump will go forward with the lawsuit if the “skinny repeal” passes or if he’ll continue paying insurers the subsidies regardless.
What If I Have A Pre-Existing Condition?
The mandate on pre-existing conditions is not affected by the “skinny repeal” bill if it’s passed. So this means that people with pre-existing conditions still can’t be denied coverage and insurers would still be required to cover specific health insurance coverage benefits that are already in place.
Will Older People Be Charged More?
No, the “skinny repeal” would not affect the ACA mandate. The would remain in place here too, people in their 60’s can’t be charged more than 3 times as much as people in their 20’s.
What Happens If I’m On Medicaid?
For people who are on Medicaid there will be no changes at all to your healthcare coverage. Also under a “skinny repeal” there isn’t any reduction of federal spending either so you’re coverage should remain exactly the same.