Inside the Senate Health Care Bill: What McConnell’s Draft Includes and What it Scraps

Independent Journal Review/Haley Byrd

Senate Majority Leader Mitch McConnell (R-Ky.) unveiled an outline of his health care bill Thursday morning, providing the first solid details of his plan since the secretive process began last month.

The draft is similar to the House bill but differs in several significant ways. Known as the Better Care Reconciliation Act, here’s what the Senate bill does:


• Repeals the ACA’s individual and employer mandates.

The individual mandate imposes a fine for people who chose not to purchase insurance, and the employer mandate fines companies if they don’t offer health coverage to employees. The GOP Senate bill scraps both.

• Rolls back Obamacare’s Medicaid expansion.

Senate Republicans would give states a Medicaid rollback like the House bill does, but it would be done over a longer period of time — spread out over three years starting in 2020. What’s more, the overall cuts to the program would be deeper over a decade than those in the House bill. About 14 million people gained insurance through Obamacare’s Medicaid expansion, which was optional for states and is geared toward older, lower-income people. The Senate bill would phase out that expansion and would cut the government’s role in paying for it to 57 percent of its funding within seven years.

• Keeps cost-sharing reduction payments. 

President Donald Trump previously threatened to cut off the subsidies to insurers, but McConnell’s plan leaves them intact for at least two years.

• Defunds Planned Parenthood.

House lawmakers cut off funding to the nation’s largest abortion services provider in their legislation, and GOP senators are looking to do the same. It could run afoul of Senate rules, though, and has been met with harsh opposition from moderate GOP senators such as Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine).

After the meeting, Murkowski scurried to an elevator and ignored questions of whether she could vote yes on a bill that defunds Planned Parenthood. Collins darted through a back hallway, avoiding reporters.

• Keeps pre-existing conditions protection rule. 

The House bill touted an amendment negotiated by conservative lawmakers to allow states to waive an ACA mandate known as community ratings that prevents insurers from charging sick people higher prices for coverage. McConnell’s draft does not include that option, much to the relief of senators such as Bill Cassidy (R-La.), who has been outspoken about pre-existing conditions protections. The move has raised the ire of conservatives in both chambers, though.

• Lets states scrap Essential Health Benefits and other rules.

Obamacare’s Essential Health Benefits set a list of conditions insurers had to cover in their plans, including maternity care and mental health treatment, among others. The Senate bill would allow states to apply for waivers from those regulations.

• Reduces taxes.

McConnell’s bill would scrap almost all of Obamacare’s taxes, with the exception of the Cadillac tax, which was imposed as an annual tax based on a percentage of the costs of coverage for individuals with abnormally high health care costs.

• Raises bar for poor people seeking subsidies for individual plan enrollment costs.

Under Obamacare, people making 400 percent of the federal poverty line and under qualified for subsidies. McConnell’s bill cuts that back to 350 percent instead.


Most Republican senators leaving the meeting McConnell led to roll out the bill told reporters they had to review it before taking positions. They’ll have to do it quickly because McConnell plans to hold a vote next week.

“It’s only 147 pages.” Sen. Bill Cassidy told reporters. “My team will work all weekend.”

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