The Senate (McConnell, really) released the draft of the “Better Care” act on Thursday. In this post I cover three questions. (1) What’s in the Senate’s “Better Care Reconciliation Act”? (2) How will the TrumpCare fight play out? (3) What can you do?
What’s in the Senate’s “Better Care Reconciliation Act”?
The Better Care Reconciliation Act: the Senate bill to repeal and replace Obamacare, explained by Sarah Kliff, a vox.com contributor on health care. (h/t Mrs. Scriber)
The bill asks low- and middle-income Americans to spend significantly more for less coverage.
The bill would roll back the Affordable Care Act’s expansion of the Medicaid program, which currently covers millions of low-income Americans, and include additional cuts to Medicaid. It would rework the individual market so that enrollees get less financial help to purchase less generous health insurance with higher deductibles.
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 program’s budget 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 seems to allow states to opt out of Obamacare’s marketplaces and essential health benefits requirement. A new waiver process would allow states to overhaul their insurance markets, including ending the essential health benefit requirement and specific subsidies that benefit low income Americans, so long as those changes do not increase the deficit.
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.
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.
Kliff has lots of detail backing up her analysis in her vox.com report.
How will the TrumpCare fight play out?
This is part of an email message from Ezra Levin, Co-Executive Director, Indivisible. (Indivisible was founded by a group of former congressional staffers who want to turn the tables on the Tea Party types in service of resisting Trump.) (h/t Laurie Jurs via Miriam Lindmeier.)
Senate Republicans have promised a vote by the end of next week. But there are still several steps between now and passage of TrumpCare. Here’s how the former congressional staff at Indivisible Team think the fight will unfurl:
- Tomorrow, we’ll get a Congressional Budget Office (CBO) score, which will quantify exactly how many millions of Americans will be screwed by this bill and in what ways.
- On Monday or Tuesday, Republicans will officially announce the vote is happening by the end of the week and start debate on “the bill,” which is just a draft bill intended to make it look like they’re being transparent but in reality is a trick to hide just how awful their finished product will be.
- Over the next couple days, Senators will submit amendments, most of which will fail and none of which would make this bill redeemable.
- On Thursday, the Senate will plan to vote on the legislation, but first they will vote on all submitted amendments (known as “vote-a-rama”).
- At the last possible minute, Senate Republicans will replace the entire bill they just got finished “debating” with an alternative TrumpCare bill secretly crafted behind closed doors.
- By the end of Thursday, there will be a final vote in the Senate.
- As soon as that same Thursday, the House may then pass the legislation and send it to Trump to sign. This could take longer, but this is the worst case scenario and quite possible.
- Next weekend, one week of congressional recess begins. They’ll either have the bill done by then, or they’ll have to wait another week.
Throughout this process there will be precisely zero public hearings in the Senate. Make no mistake, this is a historically partisan, secretive, and undemocratic process for one of the most consequential pieces of legislation of our generation. This is atrocious.
What can you do?
So let’s fight it. All you need to pressure your Republican Senators, including DAILY scripts and new materials, is on our TrumpCareTen.org website. Need more background materials? We’ve got ‘em for you here. It’s critical that you’re showing up and that when you’re not showing up, you’re calling your Senators every single day.
Here is Scriber’s post on an alliance4action call to action from a few days ago.