Senate Republicans on Thursday unveiled their long-awaited bill to replace Obamacare, anxious to make good on years of attempts to roll back the former president’s signature domestic policy achievement even while a chorus of critics warns it will strip millions of people of health benefits.
The bill comes a little more than a month after a different version squeaked through the Republican-controlled House. It mirrors many of the House bill’s provisions, such as eliminating the taxes on high income earners that underpin the vast health care expansion and limiting funding to Medicaid, while preserving some Obamacare subsidies that make coverage more affordable.
Here are some things to know about the measure, how it could affect Nevadans and where policymakers stand on it:
Fast facts about the Senate Republicans’ health bill
Nevada’s Republican Sen. Dean Heller did not go as far on Thursday after the bill’s release, saying only that he had “serious concerns” about the bill’s impact on Nevada and particularly the state’s Medicaid program. He said in a statement he would read the legislation, share it with Republican Gov. Brian Sandoval and listen to Nevadans. Sandoval said he was "disappointed" that the state wasn't included in conversations about the bill, and feared it would "dramatically" reduce coverage in the state.
What would the Senate bill do?
Reaction from Nevada leaders
Republican Sen. Dean Heller
Nevada’s moderate Republican senator, who’s up for re-election in 2018, is an important potential swing vote because the bill will fail if he and two other Republicans defect. On the other side, some Republican senators including Kentucky Sen. Rand Paul say they won’t vote for a bill that doesn’t go far enough to unravel Obama’s signature domestic policy achievement.
“Throughout the health care debate, I have made clear that I want to make sure the rug is not pulled out from under Nevada or the more than 200,000 Nevadans who received insurance for the first time under Medicaid expansion,” he said in a statement posted to his website. “At first glance, I have serious concerns about the bill’s impact on the Nevadans who depend on Medicaid. I will read it, share it with Governor Sandoval, and continue to listen to Nevadans to determine the bill’s impact on our state. I will also post it to my website so that any Nevadans who wish to review it can do so. As I have consistently stated, if the bill is good for Nevada, I’ll vote for it and if it’s not – I won’t.”
Democratic Sen. Catherine Cortez Masto
The state’s junior senator issued a statement Thursday morning saying the bill was worse than its predecessor.
“Leave it to Senate Republicans to come up with a more atrocious, callous version of the House Republican bill to repeal the Affordable Care Act and strip health care from millions of Americans – and hundreds of thousands of Nevadans. Because of the ACA, nearly 400,000 Nevadans have gained access to quality care; Senate Republicans would end Medicaid as we know it, devastating thousands of Nevada’s low-income families, children, and seniors.
“The ACA is not perfect and my Democratic colleagues and I are more than willing to work across the aisle to improve the current law so all Americans can have access to affordable, quality health care. Fast-tracking a bill that makes devastating cuts to the health coverage Nevadans rely on in an effort to hide the truth from the public is a reckless and unacceptable way to handle the lives of millions of Americans.
“Let’s be clear about this Republican bill: it does absolutely nothing to provide ‘better care’ for Americans. The Republican’s bill risks the lives of thousands of Nevadans and millions of Americans.”
Earlier in the day, she compared the legislation to a giant serpent from a children’s book. The basilisk in the Harry Potter series lives in the so-called Chamber of Secrets beneath the dungeons of the mythical wizarding school, Hogwarts, and petrifies victims with its eyes.
The freshman Democrat, who earlier this week confirmed plans to run against Heller in 2018, said the Senate bill would lead to people in her district being “personally devastated.”
“Senate Republicans are rallying around a plan that will make health care even more expensive for Nevadans and with the deep cuts to Medicaid, entirely out of reach for some of our families. It's disappointing to see how far Senate Republicans are willing to go to give the wealthiest among us a tax cut, which this bill pays for by passing the bill to hundreds of thousands of Nevadans, including vulnerable children, women, working families living paycheck to paycheck, and middle class seniors with long-term care needs who rely on Medicaid.
“The vast majority of Nevadans oppose this repeal bill because they see it for what it is: a cruel bill that implements a crushing age tax on older Americans, weakens essential health benefits protections, defunds Planned Parenthood, and strips away access to care for our most vulnerable citizens.
“People in my district will be personally devastated by this disastrous legislation. Senate Republicans should reject this partisan repeal effort and focus on working across the aisle to lower your costs and expand access to affordable health care for all Americans."
Democratic Rep. Ruben Kihuen
The freshman congressman issued a statement Thursday saying the bill would be “a tragedy” for the nation.
“It should come as no surprise that Senate Republicans are rushing their flawed health care bill to the floor without giving the American public an opportunity to understand what a tragedy this will be for our country,” he said. "This bill would be devastating for hardworking Americans and Nevadans, likely increasing the cost of their health care and threatening their ability to obtain coverage. Senate Republicans have spent weeks behind closed doors concocting this bill in secret, now they are rushing a vote on the floor just so they can skip out of town in time for the Fourth of July weekend.”
Democratic Rep. Dina Titus
Titus reaffirmed her opposition to the bill in a statement, calling it "just as callous and shameless as the House’s disastrous bill."
“Today I urged Nevada’s senators and all other lawmakers in Congress to oppose the latest version of Trumpcare,” Rep. Titus said. “The Senate’s version is just as callous and shameless as the House’s disastrous bill. It will eliminate vital care in order to shift billions of dollars to the wealthiest Americans. The repercussions of this law, just to make the rich even richer, are unimaginable. States will have fewer resources and millions will lose their health care as a result.
“By 2024, Medicaid expansion will be terminated, Medicare will lose funding, an age tax on older Americans will be implemented, and guaranteed Essential Health Benefits for cancer screenings, preventive care, and maternity care will become a thing of the past. Be assured that I will cast a no-vote on this terrible bill if it comes to the House. The cuts in this bill will hurt working families, children with disabilities, and the health of our nation at large.”
Republican Gov. Brian Sandoval
The state’s moderate Republican governor — who last week sent a letter to Senate Republican leadership urging them to hold off on wholesale changes to the health insurance law — said he was still reviewing the bill but that appeared the proposal would "dramatically reduce coverage and will negatively impact our future state budgets."
Sandoval said last week that he wouldn’t support a gradual phase-out of the expanded eligible Medicaid population in the state.
"My office and the Department of Health and Human Services are reviewing the bill and will assess its potential effect on all Nevadans. I am disappointed that Congress did not include us in the consideration of this bill and we have not seen it until today. While the current health care system needs improvement, it remains my priority to protect Nevada's expansion population to ensure our most vulnerable, especially individuals with mental illness, the drug addicted, chronically ill, and our children, will always have access to health care. Preliminarily, it appears that the proposed bill will dramatically reduce coverage and will negatively impact our future state budgets, which causes me great concern. My office is in regular communication with Senator Heller’s office and I have had ongoing discussions with the Senator about the impact of health care reform on the State of Nevada. "
Two days before the bill was released, Democratic state lawmakers held a phone bank to urge Heller to oppose the then-secret overhaul measure.
Democrats passed legislation during the recent legislative session that codified some of the most popular elements of Obamacare into state law. While Sandoval approved two measures, AB249 and SB233, that allowed no-copay contraception as long as it excluded abortion services and other preventative health services, he vetoed a more expansive bill, AB408, that would have ensured young people stay on their parents’ insurance until they’re 26, among other provisions.
Another governor-approved bill, SB394, requires the Legislative Committee on Health Care to study issues relating to ensuring Nevadans continue to have the same level of health insurance coverage they do under the ACA even if the legislation is repealed by Congress.
Democratic Assemblyman William McCurdy II, who is also the chair of the state Democratic party, called for a groundswell of opposition prior to the Senate bill being publicly released.
“After his numerous partisan votes in Washington to dismantle the Affordable Care Act, we can’t trust Dean Heller to do the right thing and protect our health care,” he said in a statement. “Now more than ever, it’s time for us to speak up and demand that Senator Heller vote against his party’s destructive, secretive health care ‘plan’ that would increase your costs and strip coverage from hundreds of thousands of Nevadans. We urge everyone to continue calling Senator Heller’s office to tell your stories, share your concerns and remind him what’s at stake with his vote.”
Nurses and hospital workers with SEIU Local 1107 planned a rally Thursday morning outside of University Medical Center in Las Vegas to protest the health bill and urge Heller to oppose it.
The union said the bill was “reckless and heartless” and “will undermine the vital role UMC plays as a public hospital in our community and jeopardize the ability for Nevada families to have the quality care they need.”
This story will be updated.