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Mitch McConnell released what he and his leadership team are calling a "discussion draft" of Trumpcare on Thursday, calling it the "Better Care Reconciliation Act" (wags immediately added "Plan" to the end of the title so we can call it BRCAP). It's being carefully presented as just a discussion bill to give Republican senators the opportunity to publicly declare that that bill "as written" is unacceptable to them, from both the extreme right and the mainstream far right that passes for "moderate" these days.
This will allow McConnell to make some tweaks—like throwing a few billion more into opioid addiction treatment, or giving Medicaid expansion one more year to exist, or making the tax credits even more penurious to keep the undeserving from getting them—that will allow factions to declare victory on their particular issues and 50 of them to support the bill. Two Senators, one of which will likely be Nevada's Dean Heller will probably be allowed to vote no. Most of the in-fighting and posturing of the next week will be who gets to be the second one.
There's a helluva lot for the so-called moderates to oppose. Any hopes that the Senate would make the bill less harsh than what the House passed last month, the American Healthcare Act (AHCA) have been dashed. Here's some of the top line destruction it will create.
It will destroy Medicaid more completely than the House bill. While it waits until 2021 to phase out Medicaid expansion, it still ends it, and with it coverage for some 14 million Americans. It makes deeper future cuts to Medicaid than the House bill, setting a limit on per-person spending for states, and tying increases in that spending limit to the overall consumer price index, a measure that grows much more slowly than the increase in health spending, the measure the House bill used. In the long term, that means Medicaid will be cut far deeper in BCRAP. It ends Medicaid as we know it. It jeopardizes coverage for 1 in 5 Americans, for half of all births, for two-thirds of all seniors in nursing homes, for three-quarters of poor children.
It gives 400 of the country's highest-earning families a $33 billion tax break, blood money for those Medicaid cuts. Those cuts "roughly equal the federal cost of maintaining the expansion in Nevada, West Virginia, Arkansas, and Alaska combined." Among those getting a big tax cut: health insurance CEOs. The Affordable Care Act taxed CEO income over $500,000, BCRAP ends that.
It allows states to reduce benefits and remove limits on annual out-of-pocket costs, affecting people with pre-existing conditions. They will lie about this one. They will say that they kept the protections for people with pre-existing conditions and that this is better than the House bill. It is not. Insurance companies will, in theory, still have to take all comers, but in states that get the waivers (and many if not most will) regulators can reduce required coverage—the "essential health benefits"—allowing insurers discretion over what's in their plans, potentially charging enrollees a great deal more for necessary benefits. This goes for people on their employer-provided plans, too. It's not just Obamacare enrollees affected.
It disproportionately hurts lower-income and older Americans even outside of the Medicaid population. Premiums would increase for people over age 60 by more than 20 percent AND decreases their tax credit compared to the AHCA. People from 50 to 64 would end up paying as much as 16.2 percent of their income for coverage. Fewer people than under Obamacare will be available for tax credits because it lowers the subsidy cap to 350 percent of the federal poverty level, as opposed to 400 percent under Obamacare.
Insurance will be less generous. Right now under Obamacare, tax subsidies are based on how much it costs to buy a midlevel, "Silver" plan that covers 70 percent of a customer's costs—the "actuarial value" of a plan. This bill would reduce that tax credit calculation to plans that cover just 58 percent of costs. Which means the plans that will be affordable in terms of premiums will have much higher deductibles and copays than under Obamacare. Add in the ability for states to waive essential health benefits requirements and the days of total junk insurance plans are back.
Planned Parenthood is defunded for one year. Medicaid patients would not be able to get their healthcare from the provider.
Like the House Trumpcare bill, this is a War on Women, War on the Poor, War on Older Americans. It is, in popular vote loser Donald Trump's words "mean, mean, mean." Meaner than the House bill Trump was describing there. The Congressional Budget Office is going to release its score for the bill "early next week," then we'll know in numbers just how mean it is.
But we don't need that score to know that millions of people's lives will be jeopardized by it.