The Senate version of the American Health Care Act is supposed to be unveiled Thursday morning, but Paige Winfield Cunningham has obtained most of the relevant details. In sum, while it seemed for a time the Senate might gesture to the center, at least a bit, its bill is about as draconian as the House version.
The tax credits for people who buy insurance on the exchanges are more generous and better targeted in the Senate version than the House version. But they’re stingier than the current system. Right now, Obamacare’s tax credits cut off for people who earn four times the poverty level, which means people just over that threshold often struggle to afford insurance. Rather than fix this problem, the Senate bill would set the cutoff even lower, to three-and-a-half times the poverty level, making insurance unaffordable for more people in the middle class.
Amazingly, the Senate bill reportedly institutes deeper Medicaid cuts than the House bill. The Senate bill would institute a longer delay to cut off the Medicaid expansion, which is how Obamacare finances insurance for the poorest people. The end result would be the same. And to help pay the cost of its more expensive tax credits, it would cut Medicaid deeply. The House version holds the program to the inflation rate plus one percent — which is historically lower than medical costs have risen, meaning that the program would have to curtail benefits for its beneficiaries, who tend to be poor and very sick. The Senate bill would cut growth down to the inflation rate, without the extra one percent.
The most important design feature is that the Senate bill retains all the tax cuts in the House bill. The tax cuts are what drive the bill’s inescapable cruelty. By eliminating nearly a trillion dollars in revenue, it necessarily creates a trillion dollars in cuts for coverage subsidies. The House bill reduces the insurance rolls by 23 million. The Senate bill won’t fare a whole lot better.
Senators have widely disparaged the House bill, and Senate moderates have talked a good game about protecting the sick and vulnerable. President Trump even admitted privately the House bill was “mean.” But the bill they’re voting on does pretty much the same thing. Now they have to decide if they want to make insurance unaffordable to millions of Americans too poor or sick to buy their own plans.