The Congressional Budget Office projected that the previous iteration would result in 22 million more uninsured in a decade. “Looking at the revised Senate health bill, it’s hard to see how it could meaningfully alter CBO’s projection of how the uninsured will grow,” the Kaiser Family Foundation’s Larry Levitt noted. “The revised Senate bill reinstates taxes on wealthy people, but it mostly does not spend that money on health care for low-income people.”
In their revision, Senate leaders tried to blunt the charge that the GOP wants to cut poor people’s health care to fund tax cuts for the rich. Taxes on wealthy people’s investment income were indeed maintained. But the bill would deeply slash Medicaid, the state-federal program covering the poor and near-poor, just as before. And it would still use the savings to fund an array of tax cuts, including a break for medical-device manufacturers. It would even add a new tax break expanding tax-advantaged health savings accounts, which would mostly benefit wealthier people who have savings to put into them.
Moderate senators who earlier claimed to have concerns about cutting off poor people have no reasonable justification for supporting this bill. If they vote for it in anticipation that its Medicaid cuts would phase in as planned, they would support a massive blow to low-income people in their states. If they vote for the bill with the calculation that future Congresses would cancel its Medicaid cuts, then their vote would likely equate to support for expanding the national debt, because the Medicaid savings are the major source of financing for the bill’s many tax cuts.
Medicaid is not the only way to cover people, of course. But the new bill would chop up the private market for individual insurance. A new provision from Sen. Ted Cruz (R-Tex.) would divide healthy people buying cheap and skimpy plans from less healthy people who want comprehensive coverage. The flimsy plans would cover little and come with few consumer protections, a grave risk for anyone who ended up needing care. The more comprehensive plans would become increasingly unaffordable as the least healthy — and therefore, to insurance companies, most expensive — customers found themselves increasingly isolated.
Even if the market avoided a death spiral, federal assistance offsetting premiums for those seeking comprehensive coverage would still be pegged to much thinner plans than the current standard. Despite GOP carping about high deductibles under Obamacare, their alternative is destined to increase these and other out-of-pocket costs.
States could lower costs with a pot of federal money set aside for experimentation and market stabilization. But these funds, even if fully appropriated, would be inadequate to the many tasks assigned them: addressing potentially skyrocketing premiums in the sicker market, ensuring that skimpier coverage does not lead people to forgo needed care and stabilizing the finances of insurers who may find the individual insurance market difficult.
The CBO, slated to release its analysis of the updated bill early next week, should have the final say. But we cannot imagine it will contain good news for the bill’s backers — nor, more important, for Americans who want access to affordable health care.
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