By Robert Reich
The Senate’s bill to repeal the Affordable Care Act is not a healthcare bill. It’s a tax cut for the wealthiest Americans, paid for by a dramatic reduction in healthcare funding for approximately 23 million poor, disabled, and working middle class Americans.
America’s wealthiest taxpayers (earning more than $200,000 a year, $250,000 for couples) would get a tax cut totaling $346 billion over 10 years, representing what they save from no longer financing healthcare for lower-income Americans.
That’s not all. The bill would save an additional $400 billion on Medicaid, which Mitch McConnell, Paul Ryan, and Donald Trump are intent on shrinking in order to cut even more taxes for the wealthy and for big corporations.
If enacted, it would be the largest single transfer of wealth to the rich from the middle class and poor in American history.
This disgrace is being proposed at a time when the nation’s rich own a higher percentage of the nation’s wealth and receive the highest percent of America’s income since the era of the Robber Barons of the late nineteenth century.
Almost all of the transfer is hidden inside a bill that’s supposed to be a kinder and gentler version of its House counterpart, which Trump called “mean, mean, mean.”
Look closely and it’s even meaner.
The Senate bill appears to retain the Affordable Care Act’s subsidies for poorer Americans. But starting in 2020, the subsidies would no longer be available for many of the working poor who now receive them, nor for anyone who’s not eligible for Medicaid.
Another illusion: The bill seems to keep the Affordable Care Act’s Medicaid expansion. But the expansion is phased out, starting in 2021.
The core of the bill – where its biggest savings come from – is a huge reduction in Medicaid, America’s healthcare program for the poor, elderly, and disabled.
This, too, is disguised. States would receive an amount of money per Medicaid recipient that appears to grow as healthcare costs rise.
But starting in 2025, the payments would be based on how fast costs rise in the economy as a whole.
Yet medical costs are rising faster than overall costs. They’ll almost surely continue to do so – as America’s elderly population grows, and as new medical devices, technologies, and drugs prolong life.
Which means that after 2025, Medicaid coverage will shrink.
The nonpartisan Urban Institute estimates that between 2025 and 2035, about $467 billion less will be spent on Medicaid than would be spent than if Medicaid funding were to keep up with the expected rise in medical costs.
The states would have to make up the difference, but many won’t want to or be able to.
One final major deception. Proponents of the bill say it would continue to protect people with preexisting conditions. But the bill allows states to reduce insurance coverage for everyone, including people with preexisting conditions.
So insurance companies could technically “cover” people with preexisting conditions for the cost of, say, their visits to a doctor, but not hospitalization, drugs, or anything else they need.
The Senate bill only seems like a kinder, gentler version of the House repeal of the Affordable Care Act, but over time it would be even crueler.
Will the American public find out? Not if McConnell can help it.
He hasn’t scheduled a single hearing on the bill.
He’s shut out major hospitals, physician groups, consumer advocates and organizations representing millions of patients with heart disease, cancer, diabetes, and other serious illnesses.
McConnell thinks he’s found a quiet way not only to repeal the Affordable Care Act but also to unravel Medicaid – and funnel the savings to the rich.
For years, Republicans have been looking for ways to undermine America’s three core social insurance programs – Medicaid, Medicare, and Social Security. The three constitute the major legacy of the Democrats, of Franklin D. Roosevelt and Lyndon Johnson. All continue to be immensely popular.
Barack Obama’s Affordable Care Act is almost part of that legacy. It’s not on quite as solid a footing as the others because it’s still new, and some wrinkles need to be ironed out. But most Americans support it.
Now McConnell believes he can begin to undo the legacy, starting with the Affordable Care Act and, gradually, Medicaid.
But he knows he has to do it in secret if he’s to be successful.
If this shameful bill is enacted, McConnell and Trump – as well as every Republican senator who signs on – will bear the burden of hundreds of thousands of deaths that could have been avoided, were they not so determined to make rich Americans even richer.
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