The Senate Republicans' "discussion draft" of Trumpcare—a bill scheduled to be voted on in one week and which has not been available to anyone but lobbyists—is now out. They're calling it the "Better Care Reconciliation Act of 2017," presumably implying that it's better than the Affordable Care Act. They sure can't claim that it's affordable.
The only real "repeal" part of it is doing away with the individual mandate that everyone have coverage. Of course, undoing that undoes the foundation of the Affordable Care Act, but the rest of the bill cuts and pastes from Obamacare. It would create a system of tax credits to subsidize health insurance—not direct subsidies that help pay premiums every month as in Obamacare—that cuts credits off at 350 percent of poverty as opposed to the ACA's 400 percent of poverty level.That reduction will hit older people disproportionately—they'll pay much more than younger people as a percentage of income, but it does offer some more assistance to lower income people than the House bill did. It requires insurance companies pay just 58 percent of costs. It will allow states to waive essential health benefits—maternity coverage, mental health coverage, even cancer treatments would be optional for insurance companies, depending on the state they're operating in.
It hastens the House bill's destruction of Medicaid. One way it does it is by setting the eligibility for buying insurance on the exchanges (which it also makes optional for states to create) to 0 percent of poverty—everyone would be "eligible" which means states could eliminate Medicaid and put the poorest people on the exchanges, people for whom tax credits don't do diddly-squat. While the Senate bill winds Medicaid expansion down more slowly than the House bill—it would start in three years—the longer term cuts to Medicaid are much deeper. It deeply reduces the federal funding allocation to states to help pay for Medicaid enrollees, putting the onus on states to figure out how to fund coverage for pregnant women, for children, for disabled adults, for seniors in nursing homes. And this bit is particularly obnoxious—it penalizes states for spending more than 25 percent of average per capita spending on patients and incentivizes states to spend less than the average. Once again, making governors make the really hard decisions on who gets help, whose lives are saved.
For tax cuts for the super rich.
It also defunds Planned Parenthood for a year, and still includes a provision barring plans selling abortion coverage from being on the exchanges, a provision that lobbyists said was being dropped because it created a rules problem under the reconciliation process. This could be a hint that McConnell is willing to go nuclear again, overruling the Senate Parliamentarian and the rules to force this through.
This bill is meaner even than the House bill. The Congressional Budget Office will demonstrate that as early as Friday when it scores it.
