It looks like those “moderate Senate Republicans” won’t be riding to the rescue…. (More)

“Some significant changes aimed at pleasing moderates”

That’s how the Washington Post’s Paige Winfield Cunningham describes Senate Republicans’ version of the Wealthcare Act, which will supposedly be unveiled today:

Senate leaders on Wednesday were putting the final touches on legislation that would reshape a big piece of the U.S. health-care system by dramatically rolling back Medicaid while easing the impact on Americans who stand to lose coverage under a new bill.

A discussion draft circulating Wednesday afternoon among aides and lobbyists would roll back the Affordable Care Act’s taxes, phase down its Medicaid expansion, rejigger its subsidies, give states wider latitude in opting out of its regulations and eliminate federal funding for Planned Parenthood.

The bill largely mirrors the House measure that narrowly passed last month but with some significant changes aimed at pleasing moderates. While the House legislation tied federal insurance subsidies to age, the Senate bill would link them to income, as the ACA does. The Senate proposal cuts off Medicaid expansion more gradually than the House bill, but would enact deeper long-term cuts to the health-care program for low-income Americans. It also removes language restricting federally subsidized health plans from covering abortions, which may have run afoul of complex budget rules.

A summary of the reported changes, both from the House version and from the ACA:

  • Premium subsides – These would be tied to income (as in the ACA), rather than age (as in the House bill). However, the Senate bill would lower the qualifying threshold to 350% of the poverty level, rather than the 400% in the ACA.
  • Non-Healthcare.gov Plans – The Senate bill would let income-qualified people use premium subsidies for plans that don’t meet the Healthcare.gov standards.
  • State Waivers – The bill would expand the current ‘1332’ waivers and let states to opt out of many ACA regulations. They could not opt out of preexisting condition coverage, they could opt out of community rating … which amounts to the same thing, as insurers could then price sick people out of the market.
  • Medicaid – The Senate bill would roll back the ACA’s Medicaid expansion (like the House bill), but would phase in the rollback more slowly. However, starting in 2025 the Senate bill would apply a per-capita cap keyed to the Consumer Price Index of inflation, rather than the CPI+1% in the House bill. The CPI+1% rate would not keep pace with the historical rate of medical cost increases, and the flat CPI rate would be worse still. Either would force states to reduce coverage as medical costs rise, and the Senate bill would force deeper cuts.

Both the Senate and House versions would defund Planned Parenthood, cutting off care to millions of poor women. But the Senate Parliamentarian held that a provision to bar people who get premium subsidies from buying health insurance that covers abortion did not comply with the Byrd Rule, the Senate bill left that provision out.

And of course, both the Senate and House versions are $1-trillion tax cuts for the wealthy … paid for by slashing health care for the working poor.

“The exact opposite of what needs to happen”

Health care blogger Charles Gaba assesses the real problems with the ACA, and how the Wealthcare Act will make them worse:

OK, so this is what the “Three-Legged Stool” of the ACA is supposed to look like for the individual market:

[Follow the link for an outstanding graphic]

Of course, I say “supposed to” because two of the three legs are simply too short, causing it to lean over somewhat.

The tax credits need to be beefed up and made available to those over the 400% FPL income threshold, and the individual mandate penalty should really be increased.

In a sane world, that’s exactly what Congress would do: Raise the cap for the tax credits, beef ’em up below that, and also bump up the mandate penalty. This wouldn’t resolve all of the ACA’s issues, but it’d take care of the most obvious/glaring ones.
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OK, so what about the SENATE version which has been kept under wraps by Mitch McConnell?
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Yes, that’s right: They want to lower the tax credit ceiling…the exact opposite of what needs to happen. And they’ll screw even more Medicaid enrollees than the House version would…they’ll just do it more slowly. Lovely.

New York Magazine’s Jonathan Chait reaches the same conclusion:

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.

“I haven’t seen it yet, either”

And those “moderate” Senate Republicans? Well, they don’t seem upset about a huge tax cut for rich people, paid for by slashing health care for poor people. So far, their objections are solely about Senate procedure:

One of the Senate Republicans charged with negotiating an Obamacare replacement expressed frustration Tuesday with the secret process, saying that even he hasn’t seen the proposal set to be released in two days for a possible floor vote next week.

“I haven’t seen it yet, either,” said Senator Mike Lee of Utah amid complaints by other Republicans that they don’t know what’s in the health-care measure being drafted by their own party’s leaders.
[…]
“Even though we thought we were going to be in charge of writing a bill within this working group, it’s not being written by us,” Lee said. “It’s apparently being written by a small handful of staffers for members of the Republican leadership in the Senate. So if you’re frustrated by the lack of transparency in this process, I share your frustration. I share it wholeheartedly.”

Note that Sen. Lee did not say that he wouldn’t vote for the bill. Neither did any of the other “moderate” Republicans quoted in that article. Senators Rand Paul (R-KY) and Ron Johnson (R-WI) are also upset about the rushed, secretive process … but neither said he would oppose the bill.

Fact is, I’ll be shocked if the bill doesn’t pass on a party-line vote, with every Senate Republican – including those mythical ‘moderates’ – voting Aye. As Josh Marshall succinctly put it, “GOP moderates always cave.”

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Photo Credit: Melina Mara (Washington Post)

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Good day and good nuts