The Senate has been working on a bill to repeal and replace the Affordable Care Act (Obamacare) for several weeks and appears likely to be ready to vote next week. The effort has been conducted entirely by Republicans because there is no support among Democrats to repeal or replace the ACA. Republicans can pass a bill with only Republican votes if they stick to rules that only allow taxes and spending to be addressed in the legislation. In that case, they only need 50 votes, and there are 52 Republicans. On most other types of legislation, Democrats could filibuster, but the Senate rules do not allow it in this case.
The Republican bill has been written by a small group of Senators and without the usual committee hearings that most major bills (including the Affordable Care Act) go through, so very little is known for certain about the content. Most Senators have not yet seen the bill draft and there will not be more than a few days to read and analyze it if they are to vote before the July 4 recess.
The bill is expected to follow the House bill in replacing the ACA insurance exchanges, where people can buy subsidized health insurance, with tax credits that will help them pay for insurance they buy on their own. The bill is likely to be somewhat more generous for older and poorer people than the House bill is. It is not yet known whether the Senate bill will allow states to eliminate mental health coverage as one of the required coverages that insurance companies must provide, as the House bill does.
The Senate is made up of both moderate Republicans and conservative Republicans. Writing a bill that will appeal to 50 of them is a challenge, and the Medicaid reforms are the biggest challenge of all. Some Senators represent states that receive increased Medicaid spending under the ACA, and others do not. How to treat those different states is problematic. Some Senators favor a significant restructuring of the program so that it costs the federal government less and the states more, if they choose to spend more. Other Senators are more cautious about that, and about how quickly the cutbacks should take place. It appears the Senate bill will go farther than the House version in cutting the Medicaid spending growth rate, tying it to a slower growth index than the House version. Funding to address the opioid crisis that will worsen with less Medicaid funding is another point of controversy.
The Senate seems likely to vote on a bill by the end of next week. If you want to look up the contact information for your senator you can click here and insert your zip code. The number for the Capitol switchboard is 202-224-3121; you can contact your Senator through this main congressional telephone number.