WASHINGTON — President Donald Trump reportedly told Republican Senate leaders at a White House luncheon earlier this week he hoped their health care bill would be less “mean” than the version House Republicans passed in May.

Thursday night, he tweeted his support for the Senate GOP draft bill released earlier in the day as the vehicle to repeal and replace the Affordable Care Act.

“I am very supportive of the Senate #HealthcareBill,” said Trump. “Look forward to making it really special. Obamacare is dead.”

Democrats and other critics of the Senate GOP measure said the bill’s feature phasing out costly aspects of Medicaid over time could eventually strip millions of low-income earners of health insurance.

Senate leaders said they needed to do something to replace and fix former President Barack Obama’s health care law, which they described as failing due to lack of public participation and high premium costs.

To make up for gradually cutting back on Medicaid coverage, the Senate plan would provide tax credits — based on age, income and geography — to lower income recipients to allow them to buy insurance.

The 31 states that expanded Medicaid coverage now cover individuals making wages too low to afford health insurance and too high to qualify for the traditional program.

The concession on tax credits was aimed at winning over moderate Republican Senators from Medicaid expansion states like West Virginia, Pennsylvania and Ohio.

But other provisions aimed at enticing conservative senators could bring more sweeping cuts to the expansion program than the health care bill approved by House Republicans.

While the House proposal would mainly cut off future Medicaid expansion recipients after 2020, the Senate version reduces funding for even those already enrolled in the program.

That would put greater pressure on cash-strapped states to come up with financing to make up the difference, drop coverage for some, or eliminate the expansion program.

In addition, the Senate plan calls for growing spending for the traditional Medicaid program more slowly than the House version, which critics say would force states to make cuts.

Robert Greenstein, president of the left-leaning Center on Budget and Policy Priorities, told reporters the Senate plan is “harsher and does even more damage than the House bill.” He said it “hits the Medicaid program so hard as almost destroying it.”

The proposal left moderates like Sen. Shelley Moore Capito, R-W.V. on the fence. She said in a statement she’s still studying the plan.

Four conservative Senate Republicans — Rand Paul, of Kentucky, Ted Cruz of Texas, Ron Johnson of Wisconsin and Mike Lee of Utah — said the Senate bill doesn’t go far enough to repeal costly provisions of Obamacare and changes need to be made to secure their support.

Senate Majority Leader Mitch McConnell said he aims to hold a vote on the plan before the lawmakers break at the end of next week for the long July 4th recess. Republicans hold only a slim majority in the Senate, and cannot afford more than two defections in order to pass their bill.

The complex legislation mirrors much of the House bill. It would repeal Obama’s signature health care law, including its requirement that all Americans sign up for insurance or pay a penalty for not doing so.

It would preserve the law’s ban on denying people coverage because of pre-existing conditions or charging them more because of their illnesses. But it would also allow states to do away with the requirement to cover essential health benefits such as mental illness and maternity services.

“We are trying to deal with the full-scale collapse of Obamacare that’s happening around us,” Sen. Pat Toomey, R-Pa., told reporters. “We’ve got to do something.”

Toomey, a member of the group of GOP senators who forged the Senate bill behind closed doors, said he’s likely to support it but did not offer an unequivocal commitment.

Republican leaders in the House faced the same challenges in March that their Senate counterparts are now confronting. Speaker Paul Ryan was forced to cancel a scheduled vote because a split between conservatives and moderates left him without enough support in his party to pass the measure. Changes were made and it squeaked by later.

Pleasing both moderates and conservatives in the Senate may prove more difficult.

In response to calls by moderates to more slowly phase in the Medicaid program cuts, the Senate version would gradually reduce the federal share of the cost from 90 beginning in 2021 until it drops to 57 percent in 2024.

To satisfy conservatives like Toomey who wanted faster cuts, those already enrolled in the program would also be subject to the cuts beginning in 2021.

Robin Rudowitz, a health care policy analyst at the Kaiser Family Foundation, said the Senate version would eventually lead to lower-income individuals losing insurance coverage in those states that couldn’t afford to make up for fewer federal health care dollars.

Contact CNHI Washington reporter Kery Murakami at kmurakami@cnhi.com.

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