Republicans on Sunday evening circulated a new version of their embattled legislation to repeal the Affordable Care Act.
Based on initial inspection, the new bill is a lot like the original bill, which would have decimated existing federal health programs, reduced government spending, and left many millions without insurance.
But now the legislation, which Politico and Vox first reported, includes a pair of important changes ― an even more aggressive assault on protections for people with pre-existing conditions, as well as some extra money to blunt the impact of funding cuts for a handful of states.
Each set of revisions seems designed to win over key Republican senators who have been critical of the legislation so far ― and to do so before Saturday, when Republicans, who hold just 52 seats in the Senate, lose parliamentary authority to pass repeal with 50 votes instead of the usual 60.
The broad architecture of the legislation, which Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) introduced in late July and have been promoting ever since, hasn’t changed all that much. As before, Republicans are proposing to replace the Affordable Care Act with a less generous state-based program, and then introduce a new, separate limit on federal Medicaid spending.
As originally written, the legislation would have left an additional 21 million people without insurance by 2026, with even more losing coverage after that, according to an estimate from the University of Southern California-Brookings Schaeffer Initiative for Health Policy.
But with Republicans clearly struggling to find 50 votes in favor of that bill, they’ve made some important revisions. And while it’s difficult to be sure exactly what all the changes mean ― analysts were still scrambling to read and digest the bill on Sunday evening ― two sets of amendments stand out as important.
How the new bill weakens pre-existing condition protections
First, there are those changes to the rules for pre-existing conditions. Under the newly revised bill, states would have an even easier time junking rules that prohibit insurers from charging higher premiums to people with cancer, diabetes, or other medical conditions. They could also waive existing rules limiting out-of-pocket expenses, or setting minimum levels of coverage.
To do this, state officials wouldn’t even have to apply for a formal waiver. All they would have to do is file a plan explaining their proposal, and why officials believe it…