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Trumpcare Takes From the Poor to Give to the Rich

New CBO report details how the Senate version of the Obamacare “repeal and replace” bill would harm tens of millions

Tim's Trumpcare CBO report analysis: 22 million uninsured, etc.

The Senate GOP health care bill would cut $772 billion from Medicaid in the first decade, according to a new report from the Congressional Budget Office.

J. Scott Applewhite/AP

Twenty two million Americans will lose insurance if the Senate’s draconian Trumpcare bill becomes law, according to an estimate released Monday by the Congressional Budget Office. Fifteen million Americans would lose coverage in the first year alone – including four million Americans who would lose the coverage they currently get through work.

The cuts under the Senate bill are bone-deep: Trumpcare axes $772 billion from Medicaid in the first decade. (The CBO projects more severe reductions in subsequent years, as the phased-in Senate cuts take full effect.) Subsidies for Americans buying individual policies are also slashed, by more than $400 million. “The average subsidy” for insurance buyers “under this legislation would be significantly lower than the average subsidy under current law,” the CBO writes.

In short, the Better Care Reconciliation Act is a formula for worse health care in America. “For all the talk of the Senate dramatically changing the House bill, it’s not much different,” tweeted Andy Slavitt, who ran Medicaid and Medicare under president Obama. “Except meaner.”

Senate Republicans use the savings won by cutting the health care of the poor, disabled, elderly and middle-class to pay for $541 million in tax cuts favoring the wealthiest Americans. The Senate bill could also create $321 billion in deficit reduction, according to the CBO, roughly $200 billion more than the House bill.

The Senate Trumpcare bill is particularly cruel to women. By cutting federal support for Planned Parenthood, the CBO estimates, Trumpcare would leave many women without a health care provider – and increase unwanted pregnancies. The report estimates that “about 15 percent” of women who “reside in areas without other health care clinics or medical practitioners who serve low-income populations” would “lose access to care” under the Senate bill. Ironically, this cut to Planned Parenthood would increase dependency on government. Because Medicaid pays for about 45 percent of all births in this country, “the additional births stemming from the reduced access under this legislation would add to federal spending for the program,” the CBO writes.

In the individual marketplace, Trumpcare would cause premiums to spike by 20 percent in the first year alone. In later years, premiums would shrink in comparison to Obamacare – largely because Trumpcare would steer Americans into lower-quality plans with higher costs at the doctor, hospital and pharmacy. “Most people” buying coverage under Trumpcare would face “higher out-of-pocket spending on health care than under current law,” according to the report. Others would face financial ruin because Trumpcare again permits the sale of policies with annual and lifetime caps on benefits.

Unlike the House-passed version – which has age-based subsidies – Senate Trumpcare preserves the income-based structure of Obamacare. But the Senate bill dramatically shrinks the benefits. The bill hits older, middle-class Americans hardest. First, the legislation allows insurers to charge older customers higher premiums based on age. Second, it eliminates subsidies for Americans of modest means altogether.

Under Obamacare, a 64-year-old making $56,000 a year would pay about $6,800 for a “silver” (i.e., decent) health care plan in 2026. Under the Senate Trumpcare bill, the same 64-year-old would be forced to pay $20,500 in premiums, according to the CBO – shelling out more than a third of annual income for health insurance, before accounting for any costs of care or drugs.

Trumpcare would also raise costs and reduce coverage for 40-year-olds making $26,500 a year, the report finds. They would pay nearly twice as much for Trumpcare than Obamacare ($3,000 vs. $1,700 a year) for significantly worse coverage (a plan that covers 70 percent of care rather than 87 percent.)

If the cuts to the private marketplace are cruel, the cuts to Medicaid in the Senate’s Trumpcare bill are downright criminal: They would kick 15 million Americans off the rolls in the first decade, cutting federal funding by more than a quarter.

Senate Trumpcare would hurt Medicaid recipients in two ways. First, it eliminates federal funding for Medicaid expansion, which has transformed the program, in many states, into universal health care for the poor and working poor. Second, it limits future Medicaid payments to the states – even as the costs of delivering health care continue to rise.

The CBO report’s bureaucratic language masks the horrific impact on the Medicaid population of 74 million Americans. But a letter to Senate Majority Leader Mitch McConnell by leading health insurers lays out some of the stakes: 24 percent of the medication used to treat opioid addiction is funded by Medicaid. And Medicaid covers 41 percent of addiction treatments in the five states with the highest percentages of overdose deaths. “Cutting Medicaid coverage will only worsen the opioid crisis,” they warn.

In a similar move, the National Association of Medicaid Directors issued a statement Monday blasting Trumpcare’s cuts as a “transfer of risk, responsibility, and cost to the states of historic proportions.” The supposed virtue of the Republican plan is that it gives states more direct control over how Medicaid is administered. But the state directors of Medicaid – who don’t agree on much, ideologically – united behind a message to Senate Republicans that “no amount of administrative or regulatory flexibility can compensate for the federal spending reductions.” The Senate’s new federal funding formula, they conclude, is “insufficient and unworkable.”

The reverse Robin Hood logic of Trumpcare is revealed in the tradeoffs created by the bill. According to the Center on Budget and Policy Priorities, Trumpcare offers a $33 billion tax cut for the richest 400 families in America, paid for by eliminating Medicaid expansion for 725,000 Americans: equivalent to the expansion population in the states of Alaska, Arkansas, Nevada and West Virginia combined.

The last word on Trumpcare this Monday comes from the American Medical Association, which concludes that the Senate bill is an affront, not just to public policy but to the guiding ethics of the profession itself. “Medicine has long operated under the precept of Primum non nocere, or ‘first, do no harm,'” the doctors’ group wrote. “The draft legislation violates that standard on many levels.”

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