All Hail ACHA 2.0

Ken AshfordCongress, Health Care, Republicans, Trump & AdministrationLeave a Comment

Well, after weeks of secrecy, the Senate version of Obamacare “Repeal and Rewhatever” (PDF) is here. Remember, the House version of the ACHA would result in 23 million people becoming uninsured, and even Trump called it “mean”.  Is the Senate version any better?  Not much:

Here is how the Senate bill works:

  • The Senate bill begins to phase out the Medicaid expansion in 2021 — and cuts the rest of the budget’s program too. The Senate bill would end the Affordable Care Act’s expansion of Medicaid to millions of low-income Americans. This program has provided coverage to more Americans than the private marketplaces
  • It would also cut the rest of the public insurance program. Better Care would also limit government spending on the rest of the Medicaid program, giving states a set amount to spend per person rather than the insurance program’s currently open-ended funding commitment.
  • The Senate bill provides smaller subsidies for less generous health insurance plans with higher deductibles. The Affordable Care Act provides government help to anyone who earns less than 400 percent of the federal poverty line ($47,550 for an individual or $97,200 for a family of four). The people who earn the least get the most help. The Senate bill would make those subsidies much smaller for many people, and only provide the money to those earning less than 350 percent of the poverty line ($41,580 for individuals and $85,050 for a family of four). The Senate bill will tether the size of its tax credits to what it takes to purchase a skimpier health insurance plan than the type of plans Affordable Care Act subsidies were meant to buy. Essentially, these tax credits buy less health insurance.
  • The Senate bill repeals the individual mandate — and replaces it with nothing. The bill gets rid of the Affordable Care Act’s unpopular requirement that nearly all Americans carry health coverage or pay a fine. This could cause significant disruption in the individual market because it takes away a key incentive healthy people have to buy coverage, meaning only sick people may sign up.  This drives up premiums, deductibles, and co-pays.
  • The bill would cut taxes for the wealthy. Obamacare included tax increases that hit wealthy Americans hardest in order to pay for its coverage expansion. The AHCA would get rid of those taxes. Obamacare was one of the biggest redistributions of wealth from the rich to the poor; the AHCA would reverse that.
  • The Senate bill defunds Planned Parenthood for one year. This would mean Medicaid patients could no longer seek treatment at Planned Parenthood clinics. Experts expect this would result in low-income Americans getting less medical care and having more unintended pregnancies, as access to contraceptives would decline.
  • All in all, the replacement plan benefits people who are healthy and high-income, and disadvantages those who are sicker and lower-income. The replacement plan would make several changes to what health insurers can charge enrollees who purchase insurance on the individual market, as well as changing what benefits their plans must cover. In aggregate, these changes could be advantageous to younger and healthier enrollees who want skimpier (and cheaper) benefit packages. But they could be costly for older and sicker Obamacare enrollees who rely on the law’s current requirements, and would be asked to pay more for less generous coverage.

Shorter story: the rich get tax breaks, the poor and sick get screwed. It’s a reverse Robin Hood bill.

Let’s recall what Sen. Mitch McConnell said about the Affordable Care Act in January:

MCCONNELL: 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, copayments 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. So it is chaotic. The status quo is simply unacceptable.

McConnell was right in every criticism he made of the ACA. Then he turned around and wrote a bill that made every single problem he identified worse.

Republicans have a mere 52-48 advantage in the Senate, so if there are two “no” Republicans, the bill could pass with VP Pence breaking the tie.  But 3 “no” Republicans would kill it (assuming, as I do, that every Dem is a “no”).  Senator Rand Paul (R) has already said “no” because it doesn’t go far enough in repealing Obamacare, but that might be posturing.

I wonder if Trump will endorse it.  After all, this is going to be thrown in his face:

Initial reaction is not good, and there are already some bad optics, like Capital Police dragging away protesters who are wheelchair-bound: