SHARPER CUTS TO MEDICAID

Over months of often bitter debate, Republicans have struggled to craft legislation that lowers costs and reduces government involvement, while minimizing the inevitable disruptions that would come with a revamp of a sector that accounts for one-sixth of the world's largest economy.

The nonpartisan Congressional Budget Office found that the House bill would kick 23 million Americans off their health plans, and the legislation is unpopular with the public. Fewer than one in 3 Americans supports it, according to Reuters/Ipsospolling.

The Senate measure maintains much of the structure of the House bill, but differs in several key ways.

The Senate bill would phase out Obamacare's expansion of the Medicaid program for the poor more gradually than the House version, waiting until after the next presidential election in 2020, but would enact deeper cuts starting in 2025. It would also allow states to add work requirements for some of the 70 million Americans who depend on the program.

The legislation also provides more generous tax subsidies than the House bill to help low-income people buy private insurance.

Those subsidies would be based on income, rather than the age-based subsidies contained in the House bill - a "major improvement," according to Republican Senator Susan Collins, a key moderate who has expressed concern over the bill's impact on the poor.

The Senate legislation provides less money, however, for the opioid epidemic, allocating $2 billion in 2018, compared with $45 billion over 10 years in the House version.

Both versions would repeal the 3.8 percent net investment income tax on high earners, a key target for Republicans.

They also would repeal a penalty imposed on large employers that do not provide insurance to their workers, and remove the fine that Obamacare imposes on those who choose to go uninsured.

Policy experts said that would keep more young, healthy people out of the market and likely create a sicker patient pool.

The Senate bill would provide money to stabilize the individual insurance market, allotting $15 billion a year in 2018 and 2019 and $10 billion a year in 2020 and 2021.

It proposes defunding Planned Parenthood for a year, but abortion-related restrictions are less stringent than the House version because of uncertainty over whether they would complywith Senate rules. They could be included in another Senatebill.

McConnell said Democrats chose not to help frame the bill,which Republicans say would fix a collapsing health market place.

"Republicans believe we have a responsibility to act, and we are," he said.

Democrats say they offered to help fix Obamacare but were rebuffed.

The bill's real-world impact is not yet known, but the CBOis expected to provide an estimate early next week.

As lawmakers spoke about the legislation on the Senatefloor, a protest erupted outside McConnell's personal office,with many people in wheelchairs blocking a hallway, holdingsigns and chanting: "No cuts to Medicaid." US Capitol Policesaid 43 protesters were arrested and charged with obstruction.

Aside from the quartet of conservatives, none of the other48 Republican senators appeared to reject the bill out of hand.

But several said they would check with home-state constituentsbefore taking a position.

"I expect there's going to be a number of changes between now and the final vote," said Senator John Barrasso of Wyoming.

Reuters