The Senate health bill: poor people pay more for worse insurance

Here’s what I think we can say about the health care bill Senate Republicans released today You’re always going to hear ‘healthcare’ as ‘complicated

’ It’s something that people say to make you turn away from it, to let them do what they want "Nobody knew that health care could be so complicated" It’s not that complicated This bill has a lot of moving parts, but you can really get down to what it does in 140 characters Health care expert Larry Levitt did it today

That is the core of this bill That is what so many of the policies in it do The first thing the bill does, the biggest thing is does, the main way it changes American health care, is it guts medicaid So beginning in 2021, Obamacare’s medicaid expansion begins to phase out That medicaid expansion was responsible for 11 of the roughly 20 million people who got covered with insurance under Obamacare From 2021 to 2024, that expansion phases out entirely

Beginning in 2025, all that’s left is the medicaid we had before Obamacare, and then the bill takes aim at that It moves that medicaid onto a growth rate that doesn’t keep up with how much healthcare actually costs So year by year, Medicaid is getting cut pretty deeply against what it actually needs to spend to cover people Now, why do you need to do all this? Why do you need to put hundreds of billions, and over time even trillions of dollars, in cuts, to the health insurance that the poorest people in this country rely on? There’s actually a reason, and you can see it right here in the bill: Those couple of words, that is a huge tax cut It’s a capital gains tax cut

Capital gains is investment income And in Obamacare, investment income on rich people got taxed a little bit more to pay for health insurance for poor people That Obamacare tax increase is repealed And in order to fund the repeal of it, the Republican party needs to gut Medicaid, they need to find a way to pay for this huge tax cut for rich people How big of a tax cut to rich people is this? A similar version of this in the house bill got looked at by the center on budget and policy parties

The 400 richest families in America would get a $33 billion tax cut That is about as much as it would cost to keep the medicaid expansion going in 4 states that are covering 700 thousand people Back to the point about insurance that covers less You’ll see on page 41 some language about essential health benefits This recurs at different points in the bill

What this does is it changes the very definition of what insurance has to cover, in order to count as insurance under the law One thing Obamacare did was to define what qualified as real insurance It had to cover things like pregnancy, like mental health, like hospitalization The Republican bill lets states waive out of the essential health benefits clause So you can have insurance that doesn’t cover hospitalization

You can have insurance that doesn’t cover pregnancy, which was very often the case before Obamacare This is important for a reason people don’t always realize In addition to meaning insurers can rip you off, with insurance that really doesn’t cover what you need it to cover, it’s also a backdoor way of making it possible to discriminate against people with pre-existing conditions If you have an expensive condition, insurance that doesn't cover anything related to that condition is not worth anything to you And you won’t sign up for it

Another really telling policy in the bill that gets at the same idea in a different way, on page 5 they change what the bill defines as ‘an applicable median cost benchmark plan’ That is obviously a beautiful turn of phrase, but what it means is that when you get subsidies under Obamacare, it’s not just tied to how much money you make It’s tied to how much a good plan costs in your area And the way the law defines a good plan is a plan that is about 70% of your expected health care costs The Republican bill changes that benchmark plan, it brings it down to 58%

That is lower than the lowest plan that most people can buy under Obamacare right now What’s remarkable about all this is that Republicans actually knew what people didn’t like about Obamacare Listen to Mitch McConnell, the guy who wrote this bill, talking about Obamacare just a few months ago: “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, co-payments 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” He’s right Those were the problems with Obamacare The bill didn't cover enough people It did have too high deductibles, it did have too much cost-sharing

It did mean that people ended up sometimes buying insurance they couldn’t use because it cost them too much to use it He understood that people were angry about it and that they wanted something better And he promised them that he would give them something better, and then he’s created a bill that is going to make every single one of those problems worse “We'd love to have some Democrat support but they're obstructionists – they'll never support We won't get one no matter how good it is

But we will hopefully get something done and it will be something with heart And very meaningful

Source: Youtube

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