WASHINGTON — Senate Republicans are reportedly close to finishing their draft bill to dismantle the Affordable Care Act – and do not plan to make it public. But the outline is enough to know that the Senate bill will be similar to the House bill in key respects – causing millions of people to lose Medicaid coverage. Rather than go down this path, the Senate should work on bipartisan reforms to stabilize and improve the ACA.

Just like the House bill, the Senate bill would cap federal funding for Medicaid. The nonpartisan Urban Institute projects that a Medicaid cap would cut federal funding for Maine by $1 billion over 10 years. Unless the state can make up the shortfall with budget cuts or tax increases, this would cause a reduction in enrollment, benefits, or payments to providers – decreasing access to care.

Just like the House bill, the Senate bill also would repeal enhanced funding for Medicaid expansion. Sen. Bill Cassidy, R-La., estimates that the loss of funding would increase costs to states by 182 percent to 400 percent, which is obviously unsustainable.

The difference between the House bill and the Senate bill is only one of timing. The House bill would repeal funding for Medicaid expansion in 2020; the Senate bill would merely delay that date by a few years. But the end result would be the same in terms of the impact on coverage after the phase-out period.

As a result of these two Medicaid policies, the nonpartisan Congressional Budget Office estimates that 14 million fewer people would be enrolled in Medicaid and instead be uninsured. If this estimate is allocated among the states, 57,300 fewer Mainers would be enrolled in Medicaid and instead be uninsured.

The CBO’s projection assumes that some states like Maine that have not expanded Medicaid will do so in the future. Although Gov. LePage has vetoed bills to expand Medicaid, Maine voters will have an opportunity to support Medicaid expansion in a referendum in November. Sen. Susan Collins also recently expressed her support for Medicaid expansion.

On another issue crucial to Maine – the impact on older enrollees – the Senate bill is unlikely to fix the problems with the House bill. Just like the House bill, the Senate bill would allow insurers to charge older enrollees five times more than they charge younger enrollees.

The CBO estimated that a 64-year-old making $26,500 would pay $14,400 more for health insurance than under the ACA in 2026. Extrapolating this estimate to Maine, a 64-year-old Mainer making $26,500 would pay $17,600 under the House bill compared with $1,700 under the ACA. Although the Senate bill is expected to boost tax credits for older people to moderate this “age tax,” Republicans have not set aside enough money to do so.

While Senate Republicans pursue a repeal bill, the insurance market is deteriorating because of massive uncertainty. In Maine, the Trump administration’s policies are driving double-digit premium rate increases for next year.

Harvard Pilgrim specifically cited President Trump’s executive order to weaken enforcement of the individual mandate, which incentivizes healthier people to buy coverage. This policy alone accounts for 40 percent of Harvard Pilgrim’s rate increase. Anthem has said it may need to increase premiums by an additional 20 percent if the Trump administration does not provide certainty on funding for ACA subsidies.

But it’s not too late; bipartisan legislation could still stabilize the insurance market:

First, it would need to guarantee continued funding for ACA subsidies. This guarantee would not actually add any costs to government spending because these subsidies are already being paid.

Second, a bipartisan bill would follow the model of states like Alaska and Maine that reimburse insurers for high-cost enrollees. In Alaska, this “reinsurance” recently lowered premium increases from 40 percent to under 10 percent.

If the federal government provided $10 billion to states for reinsurance, this would lower premiums by about 10 percent. Because this funding would lower premiums, it would save some money on tax credits, resulting in an overall cost much less than $10 billion.

Third, a bipartisan bill could use carrots and sticks to encourage insurers to enter markets where there is a single or no insurer. For instance, insurers that enter such markets could be exempted from the health insurance tax.

These policies are common-sense solutions. Insurance experts and actuaries would testify that they would be effective. The only barrier standing in the way of real improvement in insurance markets is the partisan rush to repeal the law.