After weeks of closed door negotiations, Senate Republicans on Thursday released their plan to overhaul the Obama health law, as GOP leaders again signaled they are ready to push ahead with a vote in the full Senate as early as next week.
The 142 page bill - labeled a 'discussion draft' - was posted online by the GOP, as the Senate Majority Leader made clear he's ready to move forward.
"Obamacare isn't working - by any nearly any measure it has failed," said Sen. Mitch McConnell (R-KY), who said action is needed now by the Congress.
Democrats immediately denounced the plan.
"It's every bit as bad a the House bill," said Senate Democratic Leader Charles Schumer. "In some ways, it's worse."
"I think it's a good proposal overall," said Sen. John McCain (R-AZ), trailed by a pack of reporters as he left a closed door meeting of GOP Senators where the health plan was rolled out.
"It's the first time that we've really looked at it as far as the details are concerned," McCain added.
Like McCain, many other GOP Senators had little to say about the details of the plan, having just seen them a few minutes earlier in their meeting.
"The bill is on line for all of you to read," said Sen. Bob Corker (R-TN), who was mobbed by reporters for comment.
As for what's in the GOP plan - here are some of the emerging details:
1. The plan seems to mirror what's been approved in the House. Yes, there are differences in how Senate Republicans would change provisions of the Obama health law, but the basics of the Senate plan are familiar. "In broad strokes, the Senate bill is just like the House," said Larry Levitt of the Kaiser Family Foundation, who has been a critic of GOP efforts on health care.
2. List of "Essential health benefits" for Medicaid coverage would be phased out. This is part of a two pronged effort by Republicans to make it easier to offer health coverage that does not cover all ten of the "essential health benefits" under the Obama health law - policies that require insurance companies to offer health policies that cover ten different categories of coverage, from maternity care to lab services, hospitalization, emergency care, wellness and more. This provision would end those requirements after 2019, allowing states to determine what insurance companies should cover after that date. Backers argue that will allow less expensive plans to be sold to consumers, which don't cover as many items.
3. Individual mandate penalty set a $0, made retroactive for taxpayers. Like the House bill, the Senate GOP health plan effectively gets rid of the penalty for not having health insurance coverage, as it sets the penalty at $0. But the fine print also says that provision is effect after December 31, 2015 - which means it would cover the 2016 tax year. That would seem to mean that people who paid a fine associated with their 2016 taxes could get that fine refunded.
4. Senate GOP plan also repeals Obamacare taxes. The GOP plan repeals a battery of taxes associated with the Obama health law, repealing the tax on health savings accounts, a tax on medical devices, a Medicare tax increase for higher income earners, the so-called tanning tax, and more. Some of the repeal dates are different, depending on the tax involved - for example, the medical device tax would be ended and the end of 2017, the tanning tax would end September 30, 2017, the net investment tax would be gone as of the end of 2016. Democrats say it's nothing but a giant tax cut for the rich.
5. No, this is not a repeal of Obamacare. Because this health overhaul effort is being done through the expedited process known as "budget reconciliation," it is not possible for Republicans to simply repeal the entire Affordable Care Act. Instead, this plan uses the basic structures of the Obama health law, but makes some dramatic changes along the way. Because it is not a true repeal plan, there is some heartburn in conservative circles about the details of this. But it's really the best option that Republicans have at this point, since they do not have 60 votes in the Senate to overcome a filibuster on a regular piece of legislation.
6. The protests didn't take long to start. Opponents of the GOP plan were already making their voices heard on Capitol Hill, just minutes after the details were released of the Senate Republican plan. The outcome here hinges entirely on Republicans in the Senate - if they can hold 50 votes together, then the GOP will be able to get this approved as early as next week. But because their majority is only 52-48, it would only take three GOP Senators to hold things up. It promises to be a loud next week on Capitol Hill.
7. No immediate Congressional Budget Office cost estimate. While there had been talk that the CBO would weigh in on the new Senate GOP health plan as early as tomorrow, the CBO announced early this afternoon that nothing should be expected until "early next week." That's important, because under Senate rules, there must be a CBO cost estimate before a vote on a reconciliation bill.
Already a handful of Republicans are not on board with the plan, as Senators Rand Paul (R-KY), Ted Cruz (R-TX), Mike Lee (R-UT) and Ron Johnson (R-WI) have put out a statement indicating they don't like the GOP plan - on the other end of the spectrum, Senators Susan Collins (R-ME) and Lisa Murkowski (R-AK) don't like provisions dealing with Planned Parenthood.
Still, Republicans I've talked to who support the bill feel like momentum is with them; we'll see in coming days.