SENATE REPUBLICAN leaders released on Thursday a draft health-care bill, supposedly designed to repeal and replace the Affordable Care Act. It includes a range of mostly unwise and ungenerous changes to the nation’s health-care system, but it might, if enacted, end up as mostly a massive, unpaid-for tax cut for wealthy people and industries with pull on Capitol Hill.
The bill proposes rolling back nearly all of the taxes that supported Obamacare’s health-care coverage expansion, on everything from high wages and investment income to medical devices and tanning services. It would in theory retain the “Cadillac tax” on expensive insurance plans, which is meant to discourage taxpayer-funded overspending on health care, but would delay its implementation for nearly another decade. Though the scorekeepers at the Congressional Budget Office will count the revenue the Cadillac tax would eventually raise, it is a good bet the federal government will never see any of that money. The tax has already been delayed once, and Congress has shown little interest in restraining health-care costs when doing so poses any threat to middle-class benefits.
The tax cuts are supposed to be financed by slashing health-care spending for people of limited means. Federal assistance that helps people afford insurance premiums would be scaled back, and the quality of taxpayer-subsidized insurance plans would decline. As deductibles rise, federal help with out-of-pocket medical expenses would also disappear. Meantime, Medicaid, the state-federal program covering the poor and near-poor, would endure punishing cuts over time, likely leading states to reduce enrollment, benefits or both. The only option for those falling off the Medicaid rolls would be skimpy insurance plans they could rarely if ever use.
If future Congresses allowed this policy to phase in fully, it would do away with Obamacare’s individual mandate requiring all Americans to carry insurance coverage, which could throw insurance markets badly off-kilter. States would have so much more flexibility in setting insurance rules that insurers might be able to sell plans that cover few treatments sick people really need. Even if these sorts of negative consequences were mitigated, the policy would still boil down to eroding health-coverage access and quality in order to pay for tax cuts.
The cynicism of this exercise is evident in its staging. The bill would kill a variety of taxes right away, but the subsidy and Medicaid cuts would not phase in until after the 2018 midterm election. It would be left to future Congresses to allow severe cuts to the safety net or major expansion of the federal debt, or a combination of the two. Instead of forcing this choice between Americans’ physical health and the nation’s fiscal health, senators should end this repeal-and-replace disaster now.