The big picture is that the Senate plan would, over the next decade, cut nearly $1.2 trillion of health- care spending for the poor and middle class to pay for $700 billion in tax cuts for corporations and the rich. The slightly more detailed one being that $408 billion of these cuts would come out of the Affordable Care Act's health insurance subsidies and $772 billion out of Medicaid. In any case, though, the unsurprising result is that spending $1.2 trillion less on health insurance for people would, according to the nonpartisan Congressional Budget Office, lead to 22 million fewer people having it in 10 years' time.
But even the people who managed to keep their coverage would in a lot of cases end up paying more to get less of it. There are a few reasons for this. The first is that the Senate bill would keep Obamacare's protections for people with preexisting conditions, but not its penalty for people who don't buy insurance. It would try to stop this from turning into a situation where only sick people are in the market — if you can't be denied care when you need it, why not wait until you do? — by letting younger people pay comparatively less, and imposing a six-month waiting period on anyone who had dropped their coverage. But the Brookings Institution doesn't think this would be enough to keep premiums from rising on an apples-to-apples basis at least 5 percent for a lower-tier "bronze” plan, and 9 percent for a mid-level "silver” one.
The second is that the Senate bill's smaller subsidies would make these slightly more expensive premiums much more so for a lot of people. The nonpartisan Kaiser Family Foundation estimates that the premiums people would have to pay would go up an average of 74 percent for a silver plan the next three years, with the poorest people getting hit with the biggest increases. Which is why a lot of them would be pushed into lower-cost, higher-deductible plans that might not even be lower cost for them. The CBO, after all, calculates that 64-year-olds making $68,200 or less would have to pay more for a bronze plan under the Senate bill than they do for a silver plan under Obamacare — although, in this case, it would be middle-class people who would lose the most. Consider this: A 64 year-old making $56,800 would go from paying $6,800 for a silver plan that covered 70 percent of their expected medical costs to $16,000 for a bronze plan that only covered 58 percent.
Republicans, in other words, would give people a choice between plans they couldn't afford to buy and plans they couldn't afford to use. That's the only thing you can say about pushing people into plans that would make them pay a third of their income in deductibles. Indeed, the Kaiser Family Foundation says that everyone making $18,090 or less would see their deductibles go from $255 under Obamacare to $6,105 under the Senate bill.
Trump, though, seems blissfully unaware of all this. He reportedly didn't realize that this plan would be a big tax cut for the rich when a moderate Republican senator worried about getting attacked for it. And he still doesn't seem to grasp that it would be a massive cut to Medicaid. When he was asked about that on Wednesday, all he had to say was that it would be "great for everybody”— something the 15 million people the CBO says would lose their coverage as a result of these cuts would probably disagree with. Instead, he has insisted that these $772 billion in cuts aren't cuts at all. That taking money out of a future budget isn't really taking it out as long as the budget is still getting bigger. That Medicaid will still grow, just by 36 percent less than it would have. It's not a very convincing argument.
At some point, Trump may realize that he is endorsing a health-care plan that may be even harsher than the House one he said was "mean.” But he may not care. Even though this bill wouldn't keep any of his promises, it would give him an excuse to hold another victory party in the Rose Garden. Which may be enough for him.
Trump is going to win so much, you'll get sick from it.