5 Things You Need to Know About the Senate’s Health Care Bill

5 minute read

The Senate health care bill released Thursday would cut Medicaid for low-income Americans, roll back tax hikes passed under the Affordable Care Act and allow states to waive standards on insurance coverage.

Named the Better Care Reconciliation Act to distinguish it from the House version of the bill, a “discussion draft” was released publicly Thursday after a working group of Republicans put it together behind closed doors.

Senate Majority Leader Mitch McConnell said the legislation would allow Congress to repeal the Affordable Care Act.

“The Senate will soon have a chance to turn the page on this failed law,” Senate Majority Leader Mitch McConnell said on Tuesday. “We have to act, and we are.”

Senate Democrats, meantime, cited President Trump’s remark that the House version of the bill was “mean.”

“The way this bill cuts health care is heartless,” said Senate Democratic Leader Chuck Schumer. “The president said the House bill was mean. The Senate bill may be meaner. The Senate Republicans health care bill is a wolf in sheep’s clothing, only this wolf has even sharper teeth than the House bill.”

Here’s what we know about the details of the bill and its differences between the Affordable Care Act and the the House bill, known as the American Health Care Act:

Waiving Affordable Care Act regulations

Under the Affordable Care Act, insurance companies are barred from refusing customers with pre-existing conditions and all coverage must include 10 essential health benefits, including maternity care and mental health coverage. Seniors cannot be charged more than three times the premiums of younger adults, and people with pre-existing conditions cannot be charged more than healthier people in their area. Insurers must also spend a certain amount of their revenue from premiums on claims and provide plans that cover a certain percentage of an individual’s overall health care cost.

Under the House bill, states would be able to apply for waivers to bypass these five major parts of Obamacare and establish their own guidelines for insurers.

Under the Senate bill, according to CNN, states would be allowed to apply for waivers for all but one of these five regulations: the community rating provision that prevents people with pre-existing conditions from being charged more. However, there is some doubt that this measure will survive to the final bill because of parliamentary rules on budget reconciliation bills.

Cutting Medicaid

Under the Affordable Care Act, Medicaid was expanded to include more than 10 million more lower-income Americans. After the Supreme Court ruled on the law, the expansion was made voluntary, which led some states to choose not to expand.

Under the House bill, government spending on Medicaid would decrease by about $840 billion over 10 years. The bill would also eliminate funding provided to states for Medicaid expansion by 2020, meaning no new people would be able to enroll. It would also institute a per capita cap that placed restrictions on how much money the federal government spends on each recipient and allow states to choose to receive a block grant instead.

Under the Senate bill, there will be steeper cuts to the Medicaid program. The bill would grant states a fixed amount of money each year depending on the enrollment (per capita cap) or in the form of a block grant. But Medicaid’s annual growth rate would be based on standard inflation by 2025, instead of medical inflation, causing a further slash in funds over time. In a concession to Senate moderates, the bill would instead phase out the Medicaid expansion by 2021, instead of 2020.

Ending subsidies for insurance

Under the Affordable Care Act, individuals receive subsidies to help pay for insurance plans based on their income, age, where they live, and the cost of their coverage. Overall, 85 percent of enrollees qualify for financial assistance.

Under the House bill, individuals would receive subsidies based on their age, not income, health care plan, or where they live. The House also included $138 billion over ten years for high-risk pools to help states pay for people who require more expensive care, though critics say that would not be enough. According to a recent study conducted by the AARP, premiums could surpass $25,000 per year for these high-risk patients. Also, overall, Americans would receive significantly less money under the AHCA program than they do under the current Affordable Care Act subsidies system.

Under the Senate bill, the Obamacare subsidies program will remain largely intact. However, by 2020, fewer people would receive coverage. Only individuals earning up to 350 percent of the poverty level would qualify, instead of 400 percent, as it was under Obamacare. There will also likely be more money added to the state stability fund. Though, this remains a point of contention among Republican senators.

Cutting funding for Planned Parenthood

Under the Affordable Care Act, patients could use Medicaid funds to get care at Planned Parenthood, which offers people a wide range of reproductive health care services. According to estimates, half of the 2.5 million people that go to Planned Parenthood clinics each year pay for their services with Medicaid.

Under the House bill, Planned Parenthood would lose 30 percent of its funding it gets through Medicaid reimbursements, unless the clinics stop offering abortions.

Under the Senate bill, the provisions would be the same. Planned Parenthood would be stripped of a large portion of its funding for one year.

Increasing the number of uninsured

Under the Affordable Care Act, the amount of uninsured Americans has dropped around 13.3 percent since 2013, or around 12.8 million people, according to the Census Bureau.

Under the House bill, 16 million people would lose health care by next year, and by 2026, 23 million people would be without insurance, according to CBO estimates.

Under the Senate bill, many Americans would still lose coverage, though Senators are hoping the CBO will project a smaller number of uninsured than the House bill. No one will know for sure until the CBO releases its score.

More Must-Reads from TIME

Write to Jack Brewster at jack.brewster@time.com