How the Senate GOP health bill differs from the House bill and Obamacare

Senate Republicans unveiled a "discussion draft" of their version of health care reform legislation to repeal and replace Obamacare Thursday morning, after setting aside the version of the bill the House passed last month. 

With only a slim Republican majority in the Senate, any dissent in the GOP could lead to the failure of the legislation, known as the Better Care Act. Five Republican senators have already said they cannot vote for the legislation as it stands. The Senate bill appeared shortly after White House press secretary Sean Spicer and President Trump himself said the administration wants a bill with "heart."

Mr. Trump on Thursday said the bill will need "a little negotiation, but it's going to be very good." He said he is "very supportive" of the bill.

Here is how the 2010 Affordable Care Act, also known as Obamacare, differs from the House's American Health Care Act and how they both differ from what the Senate is offering

Penalizing people without insurance

  • Obamacare: Imposed financial penalties on people who don't have insurance.
  • House GOP bill: Removes financial penalties for those without insurance. Instead, insurers would be allowed to charge a 30 percent penalty above original premiums if an insured person's coverage is interrupted for 63 days. Eliminates individual and employer mandates.
  • Senate GOP bill: Removes financial penalties for those who don't have insurance, eliminates individual and employer mandates. On Saturday, Vox reported Senate Republicans plan to add a provision imposing a six-month waiting period for buying insurance for individuals who allow coverage to lapse.

Medicaid

  • Obamacare: Expanded the insurance program by raising income threshold; widened eligibility in states that expanded Medicaid.
  • House GOP bill: Phases out Medicaid expansion under Obamacare, freezing funding for the expansion in 2020.
  • Senate GOP bill: Phases out additional funding under Obamacare by 2024 in states that expanded Medicaid; allows states to choose between a block grant funding format and per-capita funding; allows states to impose a work requirement for people who aren't pregnant, disabled or elderly.

Coverage for people with pre-existing conditions 

  • Obamacare: Insurers cannot deny coverage to people with pre-existing conditions 
  • House GOP bill: Has loopholes that could mean people with pre-existing conditions are not guaranteed coverage by allowing states to apply for waivers that could eliminate "essential benefits" that insurers have to cover. Premiums for those with pre-existing conditions could increase substantially.
  • Senate GOP bill: Preserves more protections for people with pre-existing conditions than House bill, although critics say assurances are not as iron clad as those under Obamacare. States would not be allowed to obtain waivers for Obamacare rule banning insurers from charging those with pre-existing conditions higher premiums.

Essential health care benefits

  • Obamacare: Requires insurers to provide coverage for 10 essential health care needs, like ambulatory services, emergency services, mental health and substance disorder services and pregnancy care.
  • House GOP bill: Requires insurance companies to cover such essential health benefits, but allows states to apply for waivers to eliminate the requirement to cover those services.
  • Senate GOP bill: Allows states to request a waiver to opt out of essential health benefits.

Taxes

  • Obamacare: Imposes a number of taxes, such as a 3.8 percent tax on investment income on people earning more than $200,000 per year.
  • House GOP bill: Eliminates most Obamacare taxes, such as the 3.8 percent tax on investment income. Both House and Senate bills would delay implementation of Cadillac tax on the most expensive health insurance plans until 2026.
  • Senate GOP bill: Eliminates most Obamacare taxes, such as the 3.8 percent tax on investment income.

Coverage for young people

  • Obamacare: Allows people to stay on their parents' health insurance plan until age 26
  • House GOP bill: Allows people to stay on their parents' health insurance plan until age 26
  • Senate GOP bill: Allows people to stay on their parents' health insurance plan until age 26

Abortion and contraceptive coverage

  • Obamacare: Requires insurance companies to cover birth control with no co-pay and requires insurance plans and employers that provide insurance to cover some contraception costs.
  • House GOP bill: Prohibits Medicaid funding from being used at Planned Parenthood for a year; bars the use of federal tax credits to help buy insurance plans that include abortion coverage. Unclear on birth control costs.
  • Senate GOP bill:  Prohibits Medicaid funding from being used at Planned Parenthood for a year; prohibits plans purchased using funding from the bill from covering abortions; prohibits funds allocated in the bill from going to health care providers -- like Planned Parenthood -- that are involved in abortion. Unclear on birth control costs.