STEVE INSKEEP, HOST:
Senate Republicans at last have posted their version of replacing the Affordable Care Act. This is a bill that would affect health insurance, health care which is one-sixth of the American economy. They want a vote within one week or so. And NPR's Scott Horsley has had a solid half-hour to analyze this plan. He joins us now. Hi, Scott.
SCOTT HORSLEY, BYLINE: Good to be with you, Steve.
INSKEEP: OK. Let's just remember, President Trump first celebrated a House version of this bill but then said he was hoping it would have more heart in the Senate version, that it would be more generous in some way. Is it more generous?
HORSLEY: Well, it depends, Steve. Some people who are trying to buy insurance on the individual market might do better with this plan than they would under the House-passed version. So for them, it might seem like this is a bill with more heart or a bigger government subsidy. For others, though, that's not the case, in particular when it comes to Medicaid.
Senate Republican leader Mitch McConnell says he expects the congressional forecasters to come out with their scoring of the bill next week. And that'll help us to understand the net effects, you know, who wins, who loses. In the meantime, we're all just trying to sort of crunch the numbers and see, how does this bill fare compared to the House bill and also compared to the status quo of Obamacare?
INSKEEP: Just remembering here so we can kind of keep track, Obamacare subsidized health care for millions of people and also expanded Medicaid, the health program for lower income individuals. The House plan significantly contracted the money spent in those two areas. The Senate plan, it sounds to me you're saying that that tweaks that contraction, but it's still going to be a lot less money out there. Is that right?
HORSLEY: That's right. Like the House bill, the Senate bill gradually phases out the Medicaid expansion. It's a more gradual phaseout in the Senate version but the expansion still goes away. So if you talk, you know, by 2023 or so, there is no more Medicaid expansion.
And the Senate bill is even more stingy than the House bill in funding traditional Medicaid. It would cap federal spending at a rate that is unlikely to keep pace with the actual increase in health care costs. So states would either have to make up the difference or, in many case, they'd have to push people off the Medicaid rolls.
Remember, the House bill was expected to leave 14 million fewer Americans with Medicaid coverage by 2026 than the status quo. This bill is likely to be about the same or maybe even see a steeper drop off. And keep in mind, Steve, Medicaid covers about half the babies born in this country and two-thirds of the seniors getting long-term care in nursing homes. So that would have wide-ranging effects.
INSKEEP: Wow. Well, what about people who have been buying health care on one of the Obamacare - health insurance, I should say, on one of the Obamacare exchanges?
HORSLEY: Yeah. So remember, the House plan didn't vary its subsidies with income, only age.
HORSLEY: So it wound up being better for young healthy people, especially those living in the cities where health care costs tend to be lower. It was not so good for older, sicker people and those living in rural areas, where the costs tend to be higher. The Senate bill changes that formula somewhat to take income into account.
And so as a result, we may see a smaller drop in the number of people buying coverage on the individual market than was predicted under the House bill. The House bill was expected to shed about 6 million people over the decade. But the subsidies here in the Senate bill are still less generous than those offered under Obamacare.
INSKEEP: I think I'm hearing you saying, Scott Horsley, that that classic person we've described who's in his or her mid-50s, isn't making a lot of money, was facing a huge drop-off in subsidies and might be the type of person who voted for Donald Trump, that person is going to do better under this bill but many other people it's going to be about the same.
HORSLEY: Do better than they would have under the House bill but maybe still worse than under Obamacare.
INSKEEP: Scott, thanks very much, really appreciate it.
HORSLEY: You bet.
INSKEEP: That's NPR's Scott Horsley just beginning our analysis of the Senate Republican health insurance bill. So much more still to say.
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