Lawmakers said Thursday Senate Majority Leader Mitch McConnell of Kentucky is likely to make further changes as he works to convince reluctant members of his conference to back the plan ahead of an anticipated vote next Thursday. For more newsletters, check out our newsletters page 
 
 The Senate bill would cut the subsidies for people on the individual market 
 
 The Affordable Care Act provides financial help to low- and middle-income Americans who purchase their own health coverage. vox-mark VoxCare Vox's email explaining the biggest news in health care, edited by Sarah Kliff Subscribe By signing up, you agree to our Privacy Policy and European users agree to the data transfer policy. “The typical American, in short, isn’t going to see any money from these tax cuts,” Matt Yglesias has written. That means their package can’t suddenly include tax credits that are 10 times more generous than the House bill, unless they cut other programs by trillions of dollars. 1 count on such taxpayer’s return who is 
 
 2 covered by a qualified health plan taken 
 
 3 into account under paragraph (2)(A).’’. pic.twitter.com/jcTgDGoEpH — Adrianna McIntyre (@onceuponA) June 22, 2017 
 
 Under these requirements, a state could ask for a waiver to allow insurers to longer cover things like maternity care or mental health services — two things that individual plans often left out before the Affordable Care Act mandates. The six-month waiting period fills a big policy gap in the first draft of the Better Care Reconciliation Act, which required health plans to accept all patients — but didn’t require all Americans to purchase coverage, as the Affordable Care Act does. It includes the repeal of: 
 
 A tax on investment income 
 
 A tax on the wealthy to finance the Medicare program 
 
 A tax on tanning salons 
 
 A tax on the health insurance industry 
 
 A tax on the medical device industry 
 
 Many of these tax changes would, as my colleagues have previously written, disproportionately benefit high-income Americans. 14 (a) IN GENERAL.—Subsection (a) of section 213 of 
 
 15 the Internal Revenue Code of 1986 is amended by striking 
 
 16 ‘‘10 percent’’ and inserting ‘‘7.5 percent’’. Obamacare included tax increases that hit wealthy Americans hardest in order to pay for its coverage expansion. The rate at which these payments grow is also important. The Congressional Budget Office has projected in a separate analysis that this policy change would mean no additional states expand Medicaid — and that some current expansion states would drop out of the program, resulting in millions losing coverage. 17 (b) SUNSET OF ESSENTIAL HEALTH BENEFITS RE- 
 
 18 QUIREMENT.—Section 1937(b)(5) of the Social Security 
 
 19 Act (42 U.S.C. 8 ‘‘(II) The term ‘non-expansion 
 
 9 State’ means, with respect to a fiscal 
 
 10 year, a State that is not an expansion 
 
 11 State.’’. “States will have to fill this shortfall by raising taxes, cutting enrollment, reducing benefits, or reducing provider reimbursement—all of which are difficult choices,” Matthew Buettgens, a senior research associate at the Urban Institute, wrote. 16 1396a(a)(34)) is amended by striking ‘‘in or after 
 
 17 the third month before the month in which he made 
 
 18 application’’ and inserting ‘‘in or after the month in 
 
 19 which the individual made application’’. The bill would cut taxes for the wealthy. Specifically, it would provide subsidies that make a plan with a 58 percent actuarial value (meaning, on average, it covers 58 percent of enrollees’ costs) affordable. 1 September of the previous fiscal year to 
 
 2 September of the fiscal year involved; and 
 
 3 ‘‘(ii) for each of the 1903A enrollee 
 
 4 categories described in subparagraphs (A) 
 
 5 and (B) of subsection (e)(2), the percent- 
 
 6 age increase described in clause (i) plus 1 
 
 7 percentage point; and 
 
 8 ‘‘(B) for fiscal years after 2024, for all 
 
 9 1903A enrollee categories, the percentage in- 
 
 10 crease in the consumer price index for all urban 
 
 11 consumers (U.S. city average) from September 
 
 12 of the previous fiscal year to September of the 
 
 13 fiscal year involved. 15 ‘‘(E) BLIND AND DISABLED CHILDREN.— 
 
 16 An individual who— 
 
 17 ‘‘(i) is a child under 19 years of age; 
 
 18 and 
 
 19 ‘‘(ii) is eligible for medical assistance 
 
 20 under this title on the basis of being blind 
 
 21 or disabled. Or states would have the opportunity of a block grant — a sum of money untethered from the number of people involved. Better Care would also limit government spending on the rest of the Medicaid program, giving states a set amount to spend per person rather than the insurance program’s currently open-ended funding commitment. 1 tion of the program and comply with reporting 
 
 2 requirements under this section. This program has provided coverage to more Americans than the private marketplaces It would also cut the rest of the public insurance program. 1 bility Program may elect to terminate the 
 
 2 program effective with the first day after 
 
 3 the end of the program period in which the 
 
 4 State makes the election. Obamacare opened up the program to anyone below 138 percent of the poverty line (about $15,000 for an individual) in the 31 states (plus the District of Columbia) that opted to participate. 3 ‘‘(b) INDIVIDUAL MARKET UNAFFECTED.—The re- 
 
 4 quirements of this subsection are met with respect to a 
 
 5 small business health plan if, under the terms of the plan, 
 
 6 no participating employer may provide health insurance 
 
 7 coverage in the individual market for any employee not 
 
 8 covered under the plan, if such exclusion of the employee 
 
 9 from coverage under the plan is based on a health status- 
 
 10 related factor with respect to the employee and such em- 
 
 11 ployee would, but for such exclusion on such basis, be eligi- 
 
 12 ble for coverage under the plan. It would also change the definition of what counts as “affordable” health insurance to amount for a greater chunk of Obamacare enrollees’ income. Changes for people with preexisting conditions 
 
 An extremely controversial, last-minute amendment to the House-passed health care measure would have let states opt out of some of Obamacare’s most onerous health insurance requirements—including its rule that insurers charge everyone the same price for health insurance whether or not they suffer from a preexisting health condition. 23 ‘‘(5) INDIVIDUAL MARKET.— 
 
 24 ‘‘(A) IN GENERAL.—The term ‘individual 
 
 25 market’ means the market for health insurance 
 
 130 
 
 ERN17282 Discussion Draft S.L.C. 1 vidual who is such employer (or any dependent, as 
 
 2 defined under the terms of the plan, of such indi- 
 
 3 vidual) is or was covered under such plan in connec- 
 
 4 tion with the status of such individual as such an 
 
 5 employee, partner, or self-employed individual in re- 
 
 6 lation to the plan. Join our Facebook community for conversation and updates. 14 (a) IN GENERAL.—Section 1332 of the Patient Pro- 
 
 15 tection and Affordable Care Act (42 U.S.C. You can see the language that gets removed in this helpful tweet: 
 
 So this bill aims to totally gut 1332 coverage protections. This is very different from current Medicaid funding. They also included less money for the subsidies overall.
– Senate Republicans on Thursday finally unveiled their answer to the House bill to repeal and replace the Affordable Care Act, and Vox has an explainer of what's in it. Some major sticking points: The Better Care Reconciliation Act will ask poor and middle-class Americans to pay more for less coverage, and Medicaid would be cut after expansions are rolled back. Medicaid patients would be unable to get treatment at Planned Parenthood, which would be defunded for a year. The bill also includes a tax break for the wealthy. Here's what else you need to know: First, Politico has the full text of the 142-page document Republicans are calling a "discussion draft." Three Republican senators can defeat the bill by joining Democrats to vote against it. FiveThirtyEight reports the most likely candidates are Rand Paul and Mike Lee (who don't believe it goes far enough; Paul recently said he doesn't want "ObamaCare lite") and Susan Collins and Lisa Murkowski (who want more protections for Medicaid and pre-existing conditions). ABC News reports four Republican senators have already said they won't vote for the bill without more information and negotiation: Paul, Lee, Ron Johnson, and Ted Cruz. They released a joint statement saying the bill doesn't do enough to repeal ObamaCare. The bill's writing was cloaked in such secrecy that the Week reports as of Thursday morning quite a few Republican senators still had not seen it; Murkowski, for example, told a reporter, "I am not a reporter, and I am not a lobbyist, so I've seen nothing." President Trump had called the House bill "mean" and in need of "more heart." So Scientific American takes a look to see if the Senate version fulfills that requirement. When asked by a reporter if the Senate bill had enough heart, Trump called it "very good" but in need of "a little negotiation," CNN reports. According to People, police dragged protesters—some of them in wheelchairs or wearing medical devices—away from Mitch McConnell's office and arrested them. The protesters, members of a national disability rights group, say people with disabilities are threatened by the bill. Finally, USA Today reports Senate Democrats plan to fight the bill through procedural requests to slow down the process. They called for any changes to the House's bill to be made public for at least 72 hours and be subject to CBO analysis.