The discussion draft released by the Senate today is almost certainly worse for the average person than the bill passed by the House in May. The Congressional Budget Office is working on its report, and that will give us a better sense of the numbers involved. But the draft gives enough detail to understand that this is the cruelest vision we’ve seen yet for health care in America.
The House bill handed out billions of dollars in tax cuts to the wealthiest households in America. This bill does the same. It repeals much of the ACA, including the Medicaid expansion. It drastically cuts Medicaid and permanently changes the nature of the program in a way that means states will have to ration care. And it keeps the House’s proposals to defund organizations like Planned Parenthood and let insurers charge older people five times more.
There are some important differences. One of the biggest problems with the House bill was that it gave premium assistance to people regardless of their income. Under that system, a billionaire would get the same help to buy insurance as someone earning $20,000 a year. It was an especially bad idea because people earning the lowest amount probably would not get enough help to actually afford insurance – that was one of the reasons so many people would lose insurance under the bill.
The Senate bill goes back to helping people based on their income, so the lowest-earners would get more help buying plans. But fewer people would be eligible for help – instead of providing assistance up to 400 percent of the federal poverty line, people would only be eligible at up to 350 percent (around $42,000 for a single person). The amount of assistance is also lower overall. And the plans people would be required to buy to get help – the “benchmark” plans – will have much higher cost-sharing requirements than they do today. That means higher deductibles and co-pays. The current benchmark plans are designed so that people pay 30 percent of their health care costs through deductibles and co-pays, plus their premium. The new benchmark plan design would mean people pay 42 percent of their health care costs through deductibles and co-pays, on top of paying a premium. That is more than what is allowed in the worst plans insurance companies are legally allowed to sell on the marketplaces today.
The biggest and most harmful Medicaid change, the change from an entitlement to a capped program, is still there. Now, when people are eligible for Medicaid, the state and federal government split the costs of their health care bills. Both the House and Senate versions change that so that states get a limited amount of money from the federal government, no matter how much care their population needs. But the Senate versions cuts Medicaid more deeply than the House by reducing its allowed growth rate. The House version capped Medicaid spending and allowed it to grow according to how fast medical prices increase. The Senate bill does this for a few years, but eventually reduces the growth rate to something called the Consumer Price Index. Medical prices grow faster than prices for other goods and services. If you tie Medicaid funding to those cheaper goods and services instead of the actual price of medical care, it means much deeper cuts down the line.
We’ll keep reading and sharing new information as we learn more.