The massive redistribution of wealth from poor to rich that’s masquerading as a health-care bill in the U.S. Senate is even more cruel in some ways than the bill that cleared the House and that President Donald Trump later called “mean.”
Under the bill that Majority Leader Mitch McConnell wants to whisk into law, 22 million Americans would lose their health insurance by 2026 while out-of- pocket costs would rise for the insured, according to an analysis by the nonpartisan Congressional Budget Office. Recall that Trump promised no one would lose insurance and that coverage would be better if he became president.
No wonder McConnell was forced to apply the brakes after the CBO projections were released and slow down a vote until after July 4.
The Senate bill does extend some kindnesses, to the aforementioned wealthy individuals and the drug and insurance industries in the form of tax cuts — and to the Republican politicians who are depriving the many of health care to serve the few who can put millions into political action committees and elections.
The bill protects Republican politicians by delaying much of the suffering not just until after next year’s mid-term elections but also until after 2020 when Trump, McConnell and vulnerable fellow Republicans in the Senate are up for re-election. Not until 2025 does the Senate bill start the draconian Medicaid cutbacks that would harm the elderly, children, pregnant women and people who have disabilities.
The structural changes in Medicaid proposed by McConnell have devastating implications for his home state. Almost 1 in 3 Kentuckians depend on Medicaid. Again, no wonder McConnell wants to shield himself and his Republican majority from accountability for as many election cycles as possible.
Talk about cynical.
Sen. Rand Paul and others on the far right who want to curtail the Medicaid entitlement are understandably suspicious of the bill’s delays and object that rather than removing government from health care McConnell is pushing Obamacare-lite.
More mainstream Republicans worry about the millions of their constituents who would lose insurance and health care. Democrats, who have been excluded from the drafting of the bill, are united in their opposition.
Under the McConnell plan, the pain would come sooner for people who buy insurance on the individual market. Most Americans — almost 290 million — obtain health insurance through their jobs or government programs such as Medicaid and Medicare. It’s always been easy for politicians to ignore the problems of the 22 million who fend for themselves on the individual market, which helps explain why medical bills became this country’s leading cause of bankruptcy.
Buying health insurance on the individual market became less of a gamble and more affordable with enactment in 2010 of the Affordable Care Act, the law that Republicans have promised to repeal. The combination of the insurance reforms and the ACA’s Medicaid expansion reduced the rate of non-elderly adults who have no insurance from 16 percent to 10 percent, the lowest in decades.
The Senate bill proposes tax credits for individuals with incomes up to 350 percent of the poverty level. But the CBO says premiums and deductibles would be so high that “despite being eligible for premium tax credits, few low-income people would purchase any plan.” Premiums would fall after 2019, says the CBO, after sick people can no longer afford insurance, but out-of-pocket costs would rise as states drop requirements on insurers.
The CBO projects that 4 million people would lose employer-provided insurance because the McConnell plan drops requirements that large employers provide insurance and that those without insurance pay a penalty.
The Senate bill would end the Medicaid expansion which covers 473,000 low-income Kentuckians beginning in 2021 and does so in a way that shifts more costs than the House bill onto states, raising objections from governors of both parties. By one estimate Kentucky would have to pay $853.8 million more a year in 2024 to maintain coverage for this group, including many who are at risk from opiate addiction. The Senate bill also cuts traditional Medicaid more sharply than the House bill, starting in 2025.
On paper at least, the loss of health care will free up savings in the federal budget to pay for tax cuts for corporations and the wealthy, who are McConnell’s true constituents.
But, instead of widening inequality and wiping out the progress of recent years, Congress should build on that progress and find ways to squeeze more value from our health-care dollars.