WASHINGTON, D.C. — Roughly seven weeks after the U.S. House narrowly passed legislation designed to replace much of the 2010 Affordable Care Act (ACA), GOP Senate leaders have drafted their own bill they hope to put to a vote sometime this week.

 

But at least five senators on the Republican side of the aisle already have indicated they can’t vote in favor of the measure for a variety of reasons, chief among them being that it doesn’t go far enough to them to completely repeal the signature law pushed by former President Barack Obama.

Those five senators – Rand Paul of Kentucky, Ted Cruz of Texas, Ron Johnson of Wisconsin, Mike Lee of Utah and Dean Heller of Nevada – all said they could not support the bill as it currently stands. The GOP, with a 52-48 majority, can only afford to lose two senators to win passage. Negotiations this week promise to be intense, which Paul said he looks forward to, and could change some or all of the senators’ positions.

While Senate Majority Leader Mitch McConnell (R-Ky.) pledged to write the chamber’s own bill, it nonetheless is similar to the House’s version in many ways, including scaling back the expansion of Medicaid that was the hallmark under the ACA, also known as Obamacare.

Since the ACA was passed, 31 states expanded their Medicaid programs, loosening the rules that would qualify lower-income people. Some 74 million people now are on Medicaid, up by about 14 million since ACA took effect.

The House legislation, supported only by Republicans and which passed by a single vote, would cut back a number of Obamacare taxes and cut Medicaid to the point of saving about $834 billion over a 10-year period, according to the Congressional Budget Office (CBO).

As of Sunday, the CBO had not yet weighed in on the Senate GOP bill, but McConnell said it likely would save closer to $1 trillion over 10 years and delay the full cutoff of Medicaid expansions until 2024.

Despite the time delay, it didn’t sit well with Heller, who told The Wall Street Journal that too many people would lose health insurance under the Medicaid cuts. “I cannot support legislation that takes away insurance from millions of Americans. Make no mistake, the Affordable Care Act does need fixing. But the bill in front of us today doesn’t make those fixes,” he said.

The Senate proposal is similar to the House version in that it eliminates the mandate that everyone have health insurance or face tax penalties, and it also gives states the ability to seek waivers so that some insurance policies can be more limited in what they offer.

The provision that no insurance company could deny someone coverage because of a preexisting condition – a key component of the ACA – remains in the GOP proposals, as does the ability of children up to age 26 being able to remain on their parents’ health coverage.

But subsidies offered under Obamacare to those who don’t have access to health care through jobs would be changed to tax credits based on a person’s income, reducing the amount of support offered to help those who have to buy their own policies.

Shortly before releasing the Senate’s bill last week, McConnell said he’s shooting for a full Senate vote sometime this week, and before the July 4 recess. “It won’t be easy, but that’s our goal,” he said. “We must remember that Obamacare has failed America.”