INS & OUTS

The new Republican health-care bill is no longer a secret. Here’s who it could hurt the most

Obsession
"America First"
Obsession
"America First"

The US Senate has finally released the health care bill (pdf) it has been writing behind closed doors and intends to vote on next week. Despite concerns from some lawmakers and even president Donald Trump that the bill would be too “mean” to low-income Americans—particularly those reliant on Medicaid—early reads of this new version suggest that it may hit poor voters even harder than the House version, which was passed in early May.

Here are some major features of the Senate bill, the House bill and current law:

Features Senate Trumpcare Bill House Trumpcare Bill Current law
Medicaid expansion Phases out coverage for 11 million+ low-income adults from 2020 to 2024. Effectively ends coverage for 11 million+ low-income adults in 2020. Maintains coverage expansion for people earning up to 130% of poverty-level income.
Medicaid Caps Medicaid spending at the individual level with a lower growth rate to deliver deeper cuts starting in 2025. Caps Medicaid spending at the individual level to deliver more than $800 billion in cuts to Medicaid. Annual Medicaid spending is expected to rise by .8 percentage points of GDP over the next 30 years.
Individual markets Cost-sharing subsidies funded through 2019. Premium subsidies replaced with income-based tax credits on lower level. Plan standards are lowered. Ends requirement to obtain health insurance, which will raise premiums. Eliminates cost-sharing subsidies. Premium subsidies replaced with age-based tax credits at lower level. Ends requirement to obtain health insurance, which will raise premiums. Individual markets are expected to be stable as long as current subsidies and the requirement to obtain health insurance are maintained.
Transition subsidies $50 billion through 2021 to support states through the transition to the new program and $62 billion in innovation grants. A $2 billion fund to fight opioid addition. $138 billion over ten years to ease the transition to the new program. No transition subsidies needed.
Consumer protection States can waive any federal health standards so long as they do not increase the federal budget. States can waive certain care standards and charge more for people with preexisting conditions Insurers must meet coverage standards and cannot charge more for preexisting conditions
Drug addiction treatment funding $2 billion in grants to states to address the opioid crisis. $45 billion in grants to states over ten years to address the opioid crisis. No specific funding, but Medicaid covers three in ten Americans with an opioid addiction.
Tax cuts More than $630 billion. More than $630 billion. None.

This is still a bill designed to cut taxes on the wealthy and health subsidies for low-income Americans, while teeing up the budget baseline for a clean shot at broader tax cuts down the line.

One major difference between the two bills is that the Senate bill may be more politically astute: Most of its major cuts to health care subsidies will go into effect after both the 2018 congressional election and the 2020 presidential election, insulating lawmakers who support the bill from the immediate reaction of voters experiencing the new “Trumpcare” system.

The bill, which was spearheaded by an all-male team of senators, could also be particularly harsh for women. Like the House bill, the Senate one would “defund” Planned Parenthood, and allow states to redefine what they consider “essential” health benefits. As a result, 13 million women could lose coverage to maternity care, Planned Parenthood estimates.

Early reports suggest that some Republican senators will announce their opposition to the bill as early as this afternoon. The bill can only survive three GOP defections if senate Democrats and their independent allies oppose the bill en masse, as is expected. But early objections from conservatives may simply be political theater designed to allow electorally threatened lawmakers a chance to win public points by amending the bill before final passage.

“Obamacare is dead, and we’re putting out a plan today that’s going to be negotiated,” Trump told reporters at the White House on Thursday morning. Asked if it had “enough heart,” he said “A little negotiation, but it’s going to be very good.”

Right now, most of the information we have regarding the bill is coming from the Senate Republicans who wrote it. We’ll know more about the plan in total next week when the independent Congressional Budget Office releases its own analysis of how the bill will affect federal spending and revenues, as well as national insurance coverage.

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