Here (finally), is the text of the 8-page Senate Health Care Freedom Act, the misnamed “skinny repeal” of the Affordable Care Act (ACA). This would be the final Senate bill to be voted on to repeal and/or replace the ACA.

The bill includes the defunding of Planned Parenthood and the expansion of ACA section 1332 waivers that the Senate parliamentarian has ruled would require 60 votes rather than the 50 votes required for a budget reconciliation bill.  There have been some changes to these provisions so it is unclear how the parliamentarian would rule now.

It also is not clear that the bill contains sufficient federal deficit reduction provisions to meet the requirements for a budget reconciliation bill; if it doesn’t reduce the deficit by $133 billion (the amount of deficit reduction in the bill that the House passed), it also will require 60 votes. An earlier estimate was that this bill would only reduce the deficit by $78 billion.

The Congressional Budget Office (CBO) has previously estimated that, by 2026 (after 10 years), the repeal of the individual mandate alone would result in 16 million Americans losing their health insurance and average health insurance premiums in the individual market increasing by 20%.

If the Senate passes this bill, it is so different than the American Health Care Act passed by the House that there would be a House-Senate conference committee convened to reach agreement on a common bill to send back to the House and Senate. This will drag out the repeal and replace process out for additional months. Or there is speculation that the House would simply agree to this Health Care Freedom Act as the least common denominator and get the bill to President Trump for enactment.

The Health Care Freedom Act would:

  • Repeal the individual mandate
  • Repeal the employer mandate through 2025
  • Delay the ACA’s tax on medical devices for 3 years
  • Increases the limits on contributions to Health Savings Accounts
  • Cut off federal funding to Planned Parenthood for one fiscal year
  • Defund the Prevention and Public Health fund
  • Provide additional funding for community health centers for one fiscal year
  • Expand the ACA section 1332 waiver so that states could ignore many of the ACA’s requirements for health insurance, such as ensuring a list of essential health benefits; however, a waiver would have to maintain coverage for the same numbers of state residents; the bill now provides $2 billion for states to support such waivers

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