"I knew this bill was unfixable. What I didn't count on was that it would get worse."
The latest Trumpcare bill released by Senate Majority Leader Mitch McConnell is a political dealmaker's version of putting lipstick on a pig -- taking a colossally destructive bill hurting tens of millions and dressing it up so it can win enough votes to pass.
A side-by-side comparison of the text reveals that the GOP hasn't budged an inch in its intention to cut federal subsidies of state-run Medicaid by one-third, which will severely hit the poor, single mothers with children and seniors in nursing homes.
For those buying private insurance, in addition to ending federal Obamacare subsidies, by incorporating more deregulation from Texas Sen. Ted Cruz, anyone who is not youthful and naturally healthy will see premiums rise while what is covered in those plans will shrink. That translates into a double hit, on employers buying coverage for employees and on families and individuals facing higher out-of-pocket costs in emergencies.
McConnell's new bill still ends Obamacare's provisions that stopped insurers from rejecting people with pre-existing conditions, which is almost everybody over age 50. It reinstitutes lifetime coverage caps for insurers, which will leave people exposed to medical bankruptcy. And it eliminates Obamacare's requirement that commercial insurance policies cover essential benefits, like maternity care.
"I knew this bill was unfixable. What I didn't count on was that it would get worse," tweeted Andy Slavitt, who ran Medicare, Medicaid and the Affordable Care Act for President Obama. "There is an even bigger endorsement of higher deductibles with new catastrophic plan provision."
Digging deeper into McConnell's bill, one finds apparent giveaways to try to wrest votes from Republicans who are on the fence for completely different reasons. On the furthest right, the inclusion of Cruz's amendment will create two risk pools -- one for regular policyholders and another for the very sick. People who want wide protection against chronic, catastrophic and life-threatening illnesses will be priced out of the market under the far right's fictitious banner of giving people more "freedom."
Also pandering to the tax-cutting and make-the-rich-even-richer wing of the party is the fact that McConnell's latest bill preserves 80 percent of the taxes that earlier versions were going to repeal. That's being portrayed in some mainstream media accounts as an improvement and something less than an outright giveaway, which is ludicrous. The hundreds of billions that will be taken away from Medicaid will offset these taxes.
The bill also seeks to win the support of senators from Ohio and West Virginia by putting in more money for opioid addiction treatment, and boosting state subsidies for Florida, Louisiana and other red states. It also creates a $100 billion tax break for people who open health care savings accounts, enlarging the role for those fee-skimming middlemen with an option that only people with high enough incomes can afford to establish and use. And the McConnell bill also creates another industry giveaway, a $70 billion account to shore up insurers against the economic turbulence the rest of this bill will create.
The national trade association for insurance companies is not impressed by any of this, realizing that the GOP's "fixes" are going to turn them into the most hated industry in America -- as if multitudes from coast to coast hadn't already lost their patience with rising premiums, co-pays and deductibles before 2016's "repeal and replace" charade. Their lobby group, AHIP, or America's Health Insurance Plans, railed against Cruz's proposals in lobbyist-speak earlier this week, in a press release with the sub-heading, "Policies that increase uncertainty or threaten instability should be avoided."
AHIP concluded, "The individual market faces well-documented challenges to stability, including higher premiums, lower-than-expected enrollment, fewer plan choices, and risk pool problems in certain states and markets. Policy solutions exist to create more stability in the market by reducing premiums and attracting enrollment of younger and healthier individuals. In this context, it is important that policymakers avoid policies that threaten to further increase uncertainty or threaten stability. Such policies include opening up non-compliant plans to new enrollees, bifurcating the risk pool, or allowing plans covered by different rules to compete in the same market."
This isn't Bernie Sanders; this is the insurance lobby. As for Sanders, he posted a video on his Twitter page saying this GOP-created insanity is making the strongest possible case for a national singer-payer, Medicare-for-all system. "The UK can do it, Canada can do it, France can do it, Scandinavia can do it," he said.
Meanwhile, other Washington-based health consumer lobbyists said the time has come to trash the GOP and start bipartisan talks about creating a system that meets people's needs. How that will happen, when the GOP wrote this bill in secret and ducked meetings with their constituents is anybody's guess. But that is the line being offered on Thursday.
"Today's release of the updated Better Care Reconciliation Act (BCRA) confirms what we already knew: this broken bill can't be fixed," said Joe Baker, president of the Medicare Rights Center. "This tweaked BCRA still ends Medicaid as we know it, and it still yanks health coverage out from under millions of Americans, including older adults, people with disabilities and those with pre-existing conditions."