Here’s what I think we can say about the health care bill Senate Republicans released today.
You’re always going to hear ‘healthcare’ as ‘complicated.’
It’s something that people say to make you turn away from it, to let them do what they want.
"Nobody knew that health care could be so complicated."
It’s not that complicated.
This bill has a lot of moving parts, but you can really get down to what it does in 140
characters.
Health care expert Larry Levitt did it today.
That is the core of this bill.
That is what so many of the policies in it do.
The first thing the bill does, the biggest thing is does, the main way it changes American
health care, is it guts medicaid.
So beginning in 2021, Obamacare’s medicaid expansion begins to phase out.
That medicaid expansion was responsible for 11 of the roughly 20 million people who got
covered with insurance under Obamacare
From 2021 to 2024, that expansion phases out entirely.
Beginning in 2025, all that’s left is the medicaid we had before Obamacare, and then
the bill takes aim at that.
It moves that medicaid onto a growth rate that doesn’t keep up with how much healthcare
actually costs.
So year by year, Medicaid is getting cut pretty deeply against what it actually needs to spend
to cover people.
Now, why do you need to do all this?
Why do you need to put hundreds of billions, and over time even trillions of dollars, in
cuts, to the health insurance that the poorest people in this country rely on?
There’s actually a reason, and you can see it right here in the bill:
Those couple of words, that is a huge tax cut.
It’s a capital gains tax cut.
Capital gains is investment income.
And in Obamacare, investment income on rich people got taxed a little bit more to pay
for health insurance for poor people.
That Obamacare tax increase is repealed.
And in order to fund the repeal of it, the Republican party needs to gut Medicaid, they
need to find a way to pay for this huge tax cut for rich people.
How big of a tax cut to rich people is this?
A similar version of this in the house bill got looked at by the center on budget and
policy parties.
The 400 richest families in America would get a $33 billion tax cut.
That is about as much as it would cost to keep the medicaid expansion going in 4 states
that are covering 700 thousand people.
Back to the point about insurance that covers less.
You’ll see on page 41 some language about essential health benefits.
This recurs at different points in the bill.
What this does is it changes the very definition of what insurance has to cover, in order to
count as insurance under the law.
One thing Obamacare did was to define what qualified as real insurance.
It had to cover things like pregnancy, like mental health, like hospitalization.
The Republican bill lets states waive out of the essential health benefits clause.
So you can have insurance that doesn’t cover hospitalization.
You can have insurance that doesn’t cover pregnancy, which was very often the case before
Obamacare.
This is important for a reason people don’t always realize.
In addition to meaning insurers can rip you off, with insurance that really doesn’t
cover what you need it to cover, it’s also a backdoor way of making it possible to discriminate
against people with pre-existing conditions.
If you have an expensive condition, insurance that doesn't cover anything related to that
condition is not worth anything to you.
And you won’t sign up for it.
Another really telling policy in the bill that gets at the same idea in a different
way, on page 5 they change what the bill defines as ‘an applicable median cost benchmark
plan’.
That is obviously a beautiful turn of phrase, but what it means is that when you get subsidies
under Obamacare, it’s not just tied to how much money you make.
It’s tied to how much a good plan costs in your area.
And the way the law defines a good plan is a plan that is about 70% of your expected
health care costs.
The Republican bill changes that benchmark plan, it brings it down to 58%.
That is lower than the lowest plan that most people can buy under Obamacare right now.
What’s remarkable about all this is that Republicans actually knew what people didn’t
like about Obamacare.
Listen to Mitch McConnell, the guy who wrote this bill, talking about Obamacare just a
few months ago:
“Well, what you need to understand is that there are 25 million Americans who aren’t
covered now.
If the idea behind Obamacare was to get everyone covered, that’s one of the many failures.
In addition to premiums going up, co-payments going up, deductibles going up.
And many Americans who actually did get insurance when they did not have it before, have really
bad insurance that they have to pay for and the deductibles are so high that it’s really
not worth much to them.”
He’s right.
Those were the problems with Obamacare.
The bill didn't cover enough people.
It did have too high deductibles, it did have too much cost-sharing.
It did mean that people ended up sometimes buying insurance they couldn’t use because
it cost them too much to use it.
He understood that people were angry about it and that they wanted something better.
And he promised them that he would give them something better, and then he’s created
a bill that is going to make every single one of those problems worse.
“We'd love to have some Democrat support but they're obstructionists – they'll never support.
We won't get one no matter how good it is.
But we will hopefully get something done and it will be something with heart.
And very meaningful.