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Updated 8:49 PM  |  June 22, 2017

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How will the bill stop people from ‘gaming the system’ when sick? That’s apparently still up in the air.

One of the main features of the Affordable Care Act, or Obamacare, was its requirement that most people purchase health insurance.

This was designed to address several problems, including the possibility that people would purchase coverage only when they got sick. Higher rates of health insurance were also meant to reduce the amount of uncompensated care hospitals have to provide uninsured people in emergency departments.

Neither the House nor Senate bills include this mechanism, known as the individual mandate. And the Senate bill doesn’t even include the alternative incentives contained in the House bill, which says insurers can hike rates on customers if they have a gap in coverage for more than three months.

So, how to stop people from buying coverage only when they’re sick?

“That kind of gaming of the system is a problem,” Sen. Patrick J. Toomey (R-Pa.) said Thursday afternoon on a call reporters. “There’s still discussion about how to discourage that sort of thing.”

Seems like something to watch as discussions on the bill move forward.

Toomey also said he’s “likely” to vote for the legislation. He said it needs ongoing work, but could still support it in its current form. “I don’t have a list of things at this point I must change,” Toomey said. “Everything I want is not going to happen in one bill.”

Paige Winfield Cunningham contributed.

Bill would gut critical public health funding this fall

The Senate Republican health-care bill contains a lot of budget cuts — mostly to the Medicaid program.

But federal public health initiatives would be affected too, and more quickly than they would be under the House bill.

As our colleague Lena Sun explained:

The health-care bill that Senate Republicans released Thursday would eliminate critical funds for core public health programs that make up about 12 percent of the budget for the Centers for Disease Control and Prevention. The money supports programs to prevent bioterrorism and disease outbreaks, as well as to provide immunizations and screenings for cancer and heart disease.The Senate bill would end funding starting in fiscal 2018, which begins in October. That’s more quickly than the House GOP legislation, which would gut funding for the Prevention and Public Health Fund starting in October 2018.As a provision of the Affordable Care Act, also known as Obamacare, the Prevention and Public Health Fund provides the CDC almost $1 billion annually. Since the ACA’s passage in 2010, it has been an increasingly important source of money for fundamental CDC programs.About $625 million goes directly to states and communities to address their most pressing health needs, including drug misuse, infectious diseases, lead poisoning, obesity, diabetes, hypertension, cancer and tobacco use.

Read more here.

Watch: Protesters forcibly removed, arrested after demonstrating against health-care bill

Sen. Rob Portman voices ‘real concerns’ with bill’s Medicaid cuts

One reason Senate Republicans will not find it easy to pass their health-care bill is the legislation has to please both conservatives like Sen. Ted Cruz (R-Tex.) and moderates like Sen. Rob Portman (R-Ohio.).

Portman is the leader of a group of Republican senators from states that expanded Medicaid under Obamacare.

He said Thursday he has “real concerns” with how the new GOP proposal treats Medicaid — especially provisions of the bill that “impact drug treatment at a time when Ohio is facing an opioid epidemic.”

Here’s his full statement:

As I’ve said previously, the Affordable Care Act is not working for many Ohio families and small businesses.  My goal is to create a more workable system that lowers the cost of coverage, provides access to quality care, and protects the most vulnerable in our society.  There are some promising changes to reduce premiums in the individual insurance market, but I continue to have real concerns about the Medicaid policies in this bill, especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic.I look forward to examining this new proposal carefully and reviewing the analysis by the Congressional Budget Office when it is available.  If the final legislation is good for Ohio, I will support it.  If not, I will oppose it.  As this process moves forward, I will continue to work to protect Ohio’s interests and ensure that our health care system works better for all Ohioans.
House Dems on guard for quick vote if Senate passes bill

House Minority Whip Steny H. Hoyer (D-Md.) told reporters Thursday that Democrats are on guard for the possibility that Republicans could try to quickly push their health-care bill through the House and into law if the Senate succeeds in passing it next week.

It would be a remarkably accelerated process for such a  complicated bill, but Hoyer said a quick House vote could happen under congressional rules.

“They know that if the American people know what this bill does, they are going to send a very negative response to the Republican members of the Senate and the Republican members of the House,” he said of Republicans.

House Speaker Paul D. Ryan (R-Wis.) said Thursday that it’s “premature to say” whether the House will take up a Senate-passed bill or whether Republicans would convene a conference committee to work out differences between the chambers.

Hoyer, who played a central role in passing the Affordable Care Act as majority leader in 2009 and 2010, said Republicans had “rammed through” the health bill and accused them of “absolute hypocrisy” after they accused Democrats of procedural malfeasance during the ACA’s passage.

“The process stinks,” he said.

Hoyer said that Democrats are preparing to accelerate their opposition to the health-care bill but offered no specifics. He ruled out another floor sit-in similar to the one led by Democrats a year ago in response to congressional inaction on gun control after the Orlando nightclub shooting. Republicans changed House rules this year to fine members who take pictures or shoot video on the floor as an attempt to deter future sit-ins.

“We don’t want to subtract from the substance of this bill,” he said. “We may well take action to express our outrage at the process.”

GOP health-care bill: The latest news and reactions

Senate Republicans are set to release a health-care bill that would curtail federal Medicaid funding, repeal taxes on the wealthy and eliminate funding for Planned Parenthood as part of an effort to fulfill a years-long promise to undo Barack Obama’s signature health-care law.

Follow along for the latest updates throughout the day, and check out the current whip count here.