A little bit ago, Sen. McConnell introduced text of the Health Care Freedom Act, the “skinny” repeal bill, on the Senate floor. Text is available here, and a CBO score here. A vote is expected later this evening.
The substitute amendment as introduced would:
- Repeal the individual mandate tax/penalties, retroactive to January 1, 2016, reducing revenues by $38 billion over ten years;
- Suspend the employer mandate penalties for periods from January 1, 2016 through December 1, 2024, reducing revenues by $146 billion over ten years;
- Extend the moratorium on the medical device tax from December 31, 2017 to December 31, 2020, reducing revenues by $5.8 billion over ten years;
- Increase contribution limits to Health Savings Accounts for periods between January 1, 2018 and December 31, 2020, reducing revenues by $5 billion over ten years;
- Prohibit federal funding for one year to any non-profit provider that offers elective abortions and receives more than $1 million in Medicaid funding (a change from $350 million in earlier drafts of repeal legislation, to address concerns by the Senate Parliamentarian that the provision only targets Planned Parenthood), saving $100 million over ten years;
- Eliminates funding for the Prevention and Public Health Fund for fiscal years after 2018, saving $11.1 billion over ten years;
- Increases mandatory spending for community health centers by $422 million in fiscal year 2017;
- Provides $2 billion for states to prepare and submit Section 1332 Obamacare waivers;
- Makes certain technical changes to the Section 1332 Obamacare waiver process;
- Provides for an automatic approval of Section 1332 waiver applications 45 days after submission by a state;
- Provides for a Section 1332 waiver to last for eight years unless a state requests a shorter duration, with additional eight-year renewal periods possible;
- Prohibits Department of Health and Human Services from revoking an approved Section 1332 waiver during the eight-year period;
- Does NOT amend the criteria used to determine the waivers, such that all state waivers must continue to cover as many individuals as Obamacare, and provide coverage at least as robust as under the law — a move that some conservatives may believe will severely limit states’ ability to innovate.
The Congressional Budget Office believes that the bill as a whole will reduce the deficit by a total of $178.8 billion — $135.6 billion in on-budget savings, and $43.2 billion in off-budget (i.e., Social Security) savings. In 2026, CBO believes that the substitute would, compared to current law, reduce the number of Americans in Medicaid by 7 million, the number of Americans in Exchange coverage by 6 million, and the number of Americans in employer-sponsored coverage by 2 million.
Some conservatives may be concerned that the bill does not represent a repeal of Obamacare, leaving in place most of the law’s taxes, its new entitlements, all of its regulations, and more than 400 of the 419 legislative sections of the original 2010 statute. Moreover, some conservatives may be concerned that, by effectively repealing the individual mandate but retaining Obamacare’s costly insurance regulations, the substitute would only increase the cost of health insurance for struggling middle-class families.