美国国家公共电台 NPR CHART: Who Wins, Who Loses With Senate Health Care Bill

KELLY MCEVERS, HOST:

Republicans in the Senate today released their plan to repeal 1 and replace the Affordable 2 Care Act also known as Obamacare. This long-awaited proposal marks a big step toward achieving one of the Republican Party's major goals - reversing a key part of President Obama's legacy 3. NPR's Alison Kodjak begins our coverage 4.

ALISON KODJAK, BYLINE 5: The Senate proposal is broadly similar to the bill passed by House Republicans last month. Senate Majority Leader Mitch McConnell says the plan, which he calls a discussion draft, will stabilize 6 insurance markets and cut costs to consumers.

(SOUNDBITE OF ARCHIVED RECORDING)

MITCH MCCONNELL: We agreed on the need to free Americans from Obamacare's mandates 8, and policies contained in the discussion draft will repeal the individual mandate 7 so Americans are no longer forced to buy insurance they don't need or can't afford.

KODJAK: The plan gets rid of those mandates and instead entices 9 people to voluntarily buy a policy by offering them tax credits based on age and income to help pay premiums 10. Avik Roy is a physician and founder 11 of the conservative Foundation for Research on Equal Opportunity. He says this bill is better designed than the House version because it offers more help to older people who can't afford insurance while making coverage cheaper for young, healthy people.

AVIK ROY: The bill will encourage a lot more of those individuals to buy health insurance. That in turn will make the risk pool much healthier, which will also lower premiums. And the tax credits in the bill will also be better designed.

KODJAK: But Caroline Pearson of the consulting firm Avalere Health says the bill bases its tax credits on lower-quality insurance.

CAROLINE PEARSON: If you're paying, you know, a similar percentage of income, you're getting a less-generous product under this new plan.

KODJAK: The plan keeps some popular parts of Obamacare. It allows parents to keep their kids on their policies until they turn 26, and it requires insurers to cover people with preexisting conditions. But it then allows states to ask for waivers to opt 12 out of that requirement.

PEARSON: The protections around preexisting conditions are still in place in the Senate bill, but the waiver authority gives states options that could include limiting coverage for people with pre-existing conditions.

KODJAK: Those waivers can allow states to drop some benefits required by Obamacare like maternity 13 coverage, mental health care and birth control. The bill eliminates most of the taxes imposed by the Affordable Care Act, and it bars people from using tax credits to buy policies that pay for abortion 14 and blocks Planned Parenthood from getting any money from Medicaid.

In fact, the Senate plan follows the House lead in completely changing how the government pays for health care for the poor and disabled. Today Medicaid pays for all the care people need, and the state and federal governments share the cost. But Medicaid has also been eating up an ever-larger share of federal spending, so the Republican plan puts a lid on that by rolling back the Obama-era expansion of the program and then granting states a set amount of money for each person enrolled 15. Caroline Pearson...

PEARSON: The Medicaid cuts are even more draconian 16 than the House bill was, though they take effect more gradually than the House bill did. So we're going to see very significant reductions in coverage in Medicaid and big cuts in federal funding that will result in significant budget gaps for states.

KODJAK: Several Republican senators have already said they oppose the bill, so it's unclear whether any of these proposals will become law. Alison Kodjak, NPR News, Washington.