And the non-partisan Congressional Budget Office is expected to release its analysis of the bill early next week, with a Senate vote possible before the July 4 recess.
Here's a cheat sheet of what we know, don't know and think we know on the policy front at this hour:
An under appreciated element of the House bill was the extent to which it dramatically reformed the Medicaid program.
Regulatory waivers
The waiver issue was all the rage in the House, and behind closed doors, has certainly been an area of contention in the Senate.
Senate leaders have decided to address the most contentious issue head on -- they plan to remove the waiver option for community rating, which bans insurers from charging higher premiums to those with pre-existing conditions. They will leave, or add, waivers for the following regulations:
And a note of caution: There is still no guidance as to whether these waivers will survive the Senate parliamentarian and be allowed to be in the final bill.
State stability fund
The House included $138 billion to help states and insurers cover pricey patients in a variety of ways, primarily through things like high risk pools, and to help lower consumers' costs.
This will be in the Senate bill as well, but several moderate senators have pushed for *significantly* more money for this fund. It's unclear how much will be added, but a sizable amount is likely needed to pacify senators like Susan Collins, who gave a private presentation on Maine's now-defunct high risk pool and noted for it to be taken nationwide.
Tax credits
The House bill eliminated the Affordable Care Act's subsidies, which are based on income and cost of coverage, and replaced them with tax credits based mainly on age that started at $2,000 per year and peaked at $4,000 a year.
That structure, according to analysts and Republicans alike, fell far short when it came to providing adequate financial help for lower income and older Americans.
The Senate is expected to make the tax credit more generous for these groups. There's also been a significant push from people like Alaska Sen. Lisa Murkowski to add a geographic adjustment to the credit -- something essential to ensuring her state isn't disproportionately hammered by the new subsidy structure. However, it could also further alienate conservatives, who are already upset that the tax credits are too similar to Obamacare's subsidies.
To what degree all of this would be implemented -- or if it all makes it in the final structure -- remains somewhat unclear, but the House bill included an $85 billion placeholder for the Senate to utilize, so there is room to maneuver in what would be a crucial component of securing moderate Republican support.
Opioid funds
This is a central issue for Ohio Sen. Rob Portman, whose home state relies heavily on the ACA's Medicaid expansion to finance its addiction treatment and rehabilitation.
The structure and size of the fund remains up in the air -- Portman has made clear he'd accept it through Medicaid, or via a separate fund of sorts and $45 billion over a decade has been a number that has been mentioned. But it's important enough to him -- and to several other senators from states that have been crushed by the current epidemic -- that it's likely to find its way into the bill in some form or fashion. Still, the path isn't entirely clear - conservatives have voiced concern about the new spending and structure of the fund.
Rural hospital funding
Keep a close eye on how Republicans try to address this issue -- it may be key to securing the Murkowski's support.
Alaska, according to analysts, would be hit particularly hard by the House version of the Republican American Health Care Act. The coverage losses and premium hits would be borderline catastrophic. Changes to the tax credit will address some of that, but funding for rural hospitals may be the best way to assuage some of her very real concerns.
Short-term market stabilization
GOP Senators including health committee Chairman Lamar Alexander and Wisconsin's Ron Johnson have called for some sort of short-term market-stabilization package to be included -- provisions to essentially hold the markets over until a new law could be fully implemented. What that would entail is still very much unknown.
Would they guarantee Cost Sharing Reduction funding for an additional year? Would they allow individuals to utilize subsidies outside the Obamacare exchanges in areas insurers have abandoned entirely? These are very consequential near-term question for a number of senators -- and answers (and what it would mean for the cost of an overall bill) are still lacking.
Medicaid growth rate
Conservatives are pushing to change the way the growth rate is calculated for how federal payments are made to states. The House bill would peg the growth rate to medical inflation.
A proposal that has been on the table in the Senate (and pushed heavily by Pennsylvania Sen. Pat Toomey) would, by 2025, shift measure to regular inflation, something that would result in significantly deeper spending reductions for the program. For conservatives, who call the program bloated and unsustainable, this would be a major win. But for more moderate senators, like Portman and West Virginia's Sen. Shelly Moore Capito, it's likely a non-starter. It would likely force states to cut benefits, enrollment and provider rates.
Medicaid expansion phase out
Obamacare's Medicaid expansion is going away. The question is how quickly and in what form.
The House bill froze the ability of states to join the program and essentially eliminated the expansion by ending enhanced federal funding for new enrollees in 2020. People who were continuously enrolled would be able to maintain their coverage, but the program has a high churn rate, so the House authors worked under the assumption that expansion beneficiaries would quickly dwindle and the program would end on its own.
Senators and governors from expansion states have called that funding cliff unrealistic and too draconian. Senators pitched a seven-year glide path for the program. Senate GOP leaders have countered with a three-year glide path, starting in 2020, that would gradually drop the enhanced funding to the traditional match rate for expansion states over that period.
It's still unclear whether that will fly with expansion state Republicans. How governors react will play a major role here, particularly in the case of Nevada, home to the most endangered GOP senator up for re-election next year, Dean Heller.
Obamacare taxes
Like the House bill, the taxes will be repealed. The question is when.
The House bill, at the request of conservatives both outside and inside the halls of Congress, immediately repeals most of the taxes. The issue here is financing for the bill. Senate Republicans have made clear they'd also love to immediately repeal all of Obamacare's taxes -- but they're adding new money via the tax credit, and the more gradual Medicaid expansion phase out, and to risk pools, and potentially to an opioid fund and rural hospital money.
And they're doing all of that while being required to have *at least* $133 billion in deficit savings over a 10-year period (which is actually more than is in the House bill, according to CBO.) So they need to find that money somehow. Delaying the repeal of certain taxes is a nifty way to do it, but it's something that is abhorrent to conservatives. So this remains an open question.
Abortion
The House bill prohibits federal funding for Planned Parenthood for a year. This is a major issue for Sens. Collins and Murkowski -- a potential deal-breaker for both -- who oppose limiting funds for the group. But there's a chance it's something Senate GOP leaders may not have to grapple with at all. Many aides believe the Senate Parliamentarian will strike this provision down on Byrd Rule grounds.
There's also the lingering issues of the tax credits. There is widespread speculation that they can't attach Hyde language (no federal funds for abortions) to the new credits. Without it, conservatives may have even deeper problems with the credits (and it's worth noting, conservatives are already quite uncomfortable with the credits themselves.) Should they lose the ability to attach Hyde language, plus the ability to defund Planned Parenthood, that would be a significant loss for the anti-abortion groups who have pinned major policy hopes on this bill.
Auto-enrollment
This is an idea pushed by several senators -- one that would markedly improve any CBO score's coverage numbers. It could also play a huge roll in market stabilization, essentially forcing younger, healthier people into the marketplace and as such, lowering overall costs. But it's something that would infuriate conservatives in the conference and talk of its existence in a final bill has faded in recent weeks. Experts also say it would be incredibly difficult to implement. We'll see if it somehow comes back to life.
CNN's Tami Luhby contributed to this report.
Continue reading here:
Health care: Key issues in closed-door Senate talks ...
- How good is fish for your diet? - November 8th, 2009 [November 8th, 2009]
- What foods have both fiber and protein? - November 8th, 2009 [November 8th, 2009]
- Is There Evidence That Acupuncture Works? - November 8th, 2009 [November 8th, 2009]
- What are some good fiber foods? - November 8th, 2009 [November 8th, 2009]
- Can Green Tea fight HIV infection? - November 8th, 2009 [November 8th, 2009]
- Quality of GNC Supplements - November 8th, 2009 [November 8th, 2009]
- The Gene Smart Diet - November 8th, 2009 [November 8th, 2009]
- Tips for eating in a vegetarian lifestyle - November 8th, 2009 [November 8th, 2009]
- Regarding the Starting of a new diet regimen - November 8th, 2009 [November 8th, 2009]
- Thoughts on Dropping Weight - November 8th, 2009 [November 8th, 2009]
- What do doctors think about vitamin E supplements? - November 8th, 2009 [November 8th, 2009]
- What herbs or supplements are commonly used for depression? - November 8th, 2009 [November 8th, 2009]
- Is there a safe way to lose a lot of weight? - November 8th, 2009 [November 8th, 2009]
- Diets that promise you will lose weight - November 8th, 2009 [November 8th, 2009]
- Are Fish Toxins Linked to Diabetes? - November 8th, 2009 [November 8th, 2009]
- Can Plastic Surgery Help Migraines? - November 8th, 2009 [November 8th, 2009]
- Weight Loss Surgery Eradicates Diabetes Symptoms - November 8th, 2009 [November 8th, 2009]
- Found: A Gene That Controls Fat Cells - November 8th, 2009 [November 8th, 2009]
- Sugars and Starches, what's the difference? - November 8th, 2009 [November 8th, 2009]
- Improving your health with a serving of nuts? - November 8th, 2009 [November 8th, 2009]
- Is Your Diet Causing You To Be Depressed? - December 13th, 2009 [December 13th, 2009]
- Placebo Effect: Magnetic Bracelet Therapy - December 13th, 2009 [December 13th, 2009]
- Does serotonin promote sleep? - December 13th, 2009 [December 13th, 2009]
- Decreased energy levels - Overeating, Sleep, Nutrition - February 1st, 2010 [February 1st, 2010]
- When will the body begin to cannibalize muscle tissue? - February 7th, 2010 [February 7th, 2010]
- Foods that are high in antioxidants - February 7th, 2010 [February 7th, 2010]
- Editorial: Reduce health care costs by cutting administrative overhead - April 1st, 2012 [April 1st, 2012]
- Health Care Winners: Centene, Onyxx - April 25th, 2012 [April 25th, 2012]
- Dan Morain: Nurses union puts politics ahead of health - April 25th, 2012 [April 25th, 2012]
- What's next if Obamacare falls? - April 25th, 2012 [April 25th, 2012]
- Global Managed Health Care Services Industry - April 25th, 2012 [April 25th, 2012]
- Immigration Fight Echoes Health-Care Case at High Court - April 25th, 2012 [April 25th, 2012]
- Medical Centers Lead Workplace Wellness Effort - April 25th, 2012 [April 25th, 2012]
- The next health care overhaul? Look to employers - April 25th, 2012 [April 25th, 2012]
- Capital BlueCross Hosts Community Health Care Forums Focused on Managing Costs While Maintaining Quality - April 25th, 2012 [April 25th, 2012]
- County committee to look at area health care - April 25th, 2012 [April 25th, 2012]
- President Obama Calls on Students to Tell Congress: #DontDoubleMyRate - Video - April 25th, 2012 [April 25th, 2012]
- Sen. Coburn: Competition in Health Care to Allocate Resources - Video - April 25th, 2012 [April 25th, 2012]
- Jesse Kelly health care - Video - April 25th, 2012 [April 25th, 2012]
- PHC Vision Statement (short version) - Video - April 30th, 2012 [April 30th, 2012]
- The Bioeconomy Blueprint Panel - Video - April 30th, 2012 [April 30th, 2012]
- Providence Health Care's Vision Statement - Video - April 30th, 2012 [April 30th, 2012]
- Department of Health and Human Services: Minority Health Blogger Townhall - Video - April 30th, 2012 [April 30th, 2012]
- Health care worker accused of stealing identities of brain i - Video - April 30th, 2012 [April 30th, 2012]
- Health Care Reform, Part 1 of 3 | KYVE Insiders Roundtable - Video - April 30th, 2012 [April 30th, 2012]
- Health Care Reform: The ACA and Beyond - Video - April 30th, 2012 [April 30th, 2012]
- Is Broccoli Like Health Insurance? - Video - April 30th, 2012 [April 30th, 2012]
- Did Obama make a mistake on health care? - Video - April 30th, 2012 [April 30th, 2012]
- How Democrats Lie About Health Care - Video - April 30th, 2012 [April 30th, 2012]
- Toobin on Health Care: This was a "judicial hissy-fit" - Video - April 30th, 2012 [April 30th, 2012]
- President Obama says health care law will stand - Video - April 30th, 2012 [April 30th, 2012]
- Obama Defends Health Care Law From 'Judicial Activism' - Video - April 30th, 2012 [April 30th, 2012]
- Obama Healthcare Individual Mandate - Video - April 30th, 2012 [April 30th, 2012]
- President Obama attacks Supreme Court on health care - Video - April 30th, 2012 [April 30th, 2012]
- Raw Audio: High Court Dissects Health Care Act - Video - April 30th, 2012 [April 30th, 2012]
- Health care on trial - Video - April 30th, 2012 [April 30th, 2012]
- Final Day of Health Care Law Arguments Before Supreme Court - Video - April 30th, 2012 [April 30th, 2012]
- Feds to put up $1.9B for Oregon health overhaul - May 4th, 2012 [May 4th, 2012]
- Scuttling health care act will freeze Medicare, White House warns - May 4th, 2012 [May 4th, 2012]
- U.S. Health Care Spending High, But Quality Lags: Report - May 4th, 2012 [May 4th, 2012]
- Yes, the Health-Care Mandate Is About Liberty - May 4th, 2012 [May 4th, 2012]
- Health center gets $1M federal grant - May 4th, 2012 [May 4th, 2012]
- Health-care reform panel considers exchange options for Va. - May 4th, 2012 [May 4th, 2012]
- Hmong health care gap focus of Healthy House dinner - May 4th, 2012 [May 4th, 2012]
- Walsh-led health bill to be unveiled - May 4th, 2012 [May 4th, 2012]
- Ontario health system confusing for ailing seniors, study finds - May 4th, 2012 [May 4th, 2012]
- 'Health Care Deserts' More Common in Black Neighborhoods - May 5th, 2012 [May 5th, 2012]
- With federal money, Oregon kicks health care reform into high gear - May 5th, 2012 [May 5th, 2012]
- Nurse practitioners tackling more 'doctor' tasks - May 5th, 2012 [May 5th, 2012]
- Konza Prairie Health Center Receives $4.5 Million Grant - May 5th, 2012 [May 5th, 2012]
- Alberta wages hurting Sask. health care - May 5th, 2012 [May 5th, 2012]
- House releases plan to cut growth of Massachusetts health spending in half - May 5th, 2012 [May 5th, 2012]
- Mass. House Will Unveil Bill Seeking To Rein In Health Costs - May 5th, 2012 [May 5th, 2012]
- President Obama Welcomes the Kentucky Wildcats - Video - May 5th, 2012 [May 5th, 2012]
- President Obama Speaks on College Affordability - Video - May 5th, 2012 [May 5th, 2012]
- My First Job: Gene Sperling - Video - May 5th, 2012 [May 5th, 2012]
- Health-care costs worry near-retirees - May 7th, 2012 [May 7th, 2012]
- Massachusetts Institutes Health-Care Price Controls. Is America Next? - May 7th, 2012 [May 7th, 2012]
- Massachusetts Moves Toward Health-Care Price Controls. Is America Next? - May 7th, 2012 [May 7th, 2012]
- GOP plan boosts Pentagon, cuts social programs - May 7th, 2012 [May 7th, 2012]