Senate Republicans finally released the text of their so-called “skinny repeal” bill, which they have dubbed the Health Care Freedom Act. The emergence of what had been a bit of a mystery bill came Thursday night, hours before they are expected to vote on it. Republicans say the bill is serving as a vehicle just to get Republicans to the next step of the legislative process: a conference with the House-passed Obamacare replacement legislation, where in theory a bill will be hashed out that can pass in both chambers.
The bill repeals only a few provisions of the Affordable Care Act, but most Senate Republicans have said that they do not want this to become law.
Despite having been called colloquially a “skinny bill” in the days before its much-anticipated unveiling, it would impose sweeping changes to the individual market.
The individual mandate would be repealed immediately and retroactively under the legislation. Insurers, experts and even many Republican have said that nixing the mandate without some other continuous coverage requirement will hike premiums and destabilize. The employer mandate is repealed as well, though only through 2025.
The legislation tweaks the waiver process where states can opt-out out of some of Affordable Care Act’s requirements, putting protections for pre-existing conditions at risk. The waiver provisions in this bill appear to be less aggressive than what was in previous Obamacare replacement bills, in that it maintains many of the requirements that states must meet to obtain a waiver, but with a more streamlined process.
Under the legislation, however, a waiver would last for eight years and the Secretary of Health and Human Services would not be able to revoke a waiver before its expiration. Nicholas Bagley, a health and administrative law professor at the University of Michigan, argued that the language invited states to pitch waivers that aspire to meet the ACA’s coverage requirements, but if they fall short in implementation, allow the HHS no recourse to revoke the waivers until they expire.
“So while the ACA’s guardrails are still in place, states can ignore them once a waiver has been granted. And there’s not a thing the federal government can do about it,” he wrote at the blog The Incidental Economist.
The legislation contains language that appears to defund Planned Parenthood.
The bill also beefs up Health Savings Counts and repeals the medical device tax for three years.
Read the bill here: