Vol. 32: Speak Now or Obamacare RIP

Speak Now or Obamacare RIP

I would normally try to describe the bill to you in my barely adequate prose, however, today we’re lucky enough to have a summary from someone a bit more eloquent, former President Barack Obama:

“The Senate bill, unveiled today, is not a health care bill. It’s a massive transfer of wealth from middle-class and poor families to the richest people in America. It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else. Those with private insurance will experience higher premiums and higher deductibles, with lower tax credits to help working families cover the costs, even as their plans might no longer cover pregnancy, mental health care, or expensive prescriptions. Discrimination based on pre-existing conditions could become the norm again. Millions of families will lose coverage entirely.”

A few of the features of the Senate bill:

• Cuts Medicaid by an estimated 25% over the coming years. 64% of nursing home residents, 49% of births, 76% of poor children, 30% of adults with disabilities, and 20% of all Americans are supported by Medicaid.
• Reduces both the number of people eligible for health insurance premium subsidies and the dollar amount of those subsidies. Topher Spiro, Senior Fellow at the Center for American Progress, provided a couple examples of what that really means: a middle income 60-year-old in Maine would face a 208% premium increase, in West Virginia a 213% increase, and in Alaska, a 552% increase – over $30,000 per  year.
• Allows states to require people re-apply for Medicaid as often as every month.
• Allows states to waive requirements on what is covered by insurance, so they can approve policies without, for example, emergency care, cancer treatment, maternity care, and abortion services.
• Allows for the introduction of annual and lifetime coverage caps. For those of you on employer-provided coverage, these restrictions may make their way into your plan again.
• Bans Planned Parenthood, which provides services like pap smears, breast exams, and HIV tests to 2.4 million people annually, from receiving Medicaid reimbursements for one year.
• Eliminates Medicare tax of 0.9% on earnings and a 3.8% investment income tax, for those making over $200k. This may not seem like much, but according to Vox, eliminating these taxes on just the richest 400 families in the United States costs the same as providing Medicare expansion in Alaska, Arkansas, Nevada, and West Virginia combined.

But wait, there’s more! The Republicans are planning to introduce on Monday a requirement that if someone has a lapse in coverage, she is locked out of the insurance market for six months. In practice, this means when someone misses a payment, her insurance will likely be canceled. She will need to wait six months before she can apply again and at that point may not be offered equivalent insurance at the same price. Imagine how this will affect someone going through treatment for cancer.
 
What will all these changes mean? Atul Gawande, who recently published an article on the impact of health care in the New England Journal of Medicine, put it simply: “There will be deaths.” The Center for American Progress estimates that the coverage losses from this bill, which when fully in effect in 2026, will result in 18,100 to 27,700 additional deaths that year alone.
 
The Republicans are trying to pass an unpopular bill that will raise premiums, provide worse coverage, and lead to the early death of thousands annually – all to undo something that Obama did and to give the richest 1% a large tax break.
 
There is no defense for this bill, and that is why you have not seen or heard Republicans making a truthful case for it. The best Senator John Cornyn (R-TX) could muster was to boast that their bill is 142 pages long compared to 2,700 pages for the Affordable Care Act. After calling the more benign House bill “mean” last week, Trump resorted to blatantly lying about the bill’s impact through Sean Spicer: “[Trump’s] committed to making sure that no one who currently is in the Medicaid program is affected in any way, which is reflected in the Senate bill and he’s pleased with that.”
 
What Comes Next?
The Congressional Budget Office will release its analysis on Monday. Traditionally, the CBO looks at a 10-year time frame. Republicans, consequently, wrote the bill so that the harshest Medicaid cuts fall just outside of the 10-year window. The CBO can look longer if they want though.  How the CBO analyzes the impact of the bill may determine the outcome.

Shortly after the CBO announcement, the Senate parliamentarian will rule if the bill follows the rules of that body. The Republicans are using something called “Reconciliation”, which prevents the Democrats from filibustering the bill. Reconciliation requires that the bill follow certain rules. If the parliamentarian says that it violates the rules (most likely rule violator: stopping Planned Parenthood reimbursement), the Republicans will need to make changes to the bill or blow up the legislative filibuster altogether.
 
After that ruling, things will move very quickly. Despite holding hearings this year on important topics like hot tub safety, the Senate will not hold hearings on this bill. By comparison, there were 100 hearings on the Affordable Care Act before it was approved.
 
The Republicans can only lose 2 votes from their own party and still pass the bill. A handful of Republicans have come out against the bill “as written”.  Four of them, Senators Ted Cruz (TX), Rand Paul (KY), Mike Lee (UT), and Ron Johnson (WI), think the bill doesn’t go far enough in repealing the ACA. But even without any changes, there is no way these four actually stop the Affordable Care Act from being repealed. In 2013, Ted Cruz read “Green Eggs and Ham” in a filibuster attempt of Obamacare. If Cruz stops this bill from being approved, I’ll eat all 142 pages of the bill in a box with a fox. Expect McConnell to throw these four some cruel bone and they’ll get out of the way.
 
The only hope is a few Republicans from purple states decide not to vote to kill their constituents. Senator Dean Heller (R-NV) has come out against it. He boldly called out that the doctor has no scrubs, saying it is a “lie” that this bill would lower premiums. Almost immediately, a pro-Trump PAC, America First Policies, announced a seven figure media campaign against Heller. Yes, Republicans are attacking Republicans. This friendly fire serves as a warning to Senators Shelly Moore Capito (WV), Bill Cassidy (LA), Susan Collins (ME), Lisa Murkowski (AK), Rob Portman (OH), and Ben Sasse (NE) to not break rank.
 
If the Senate passes this, the buzz is the House will pass that version immediately, putting it on Trump’s desk so he can declare independence from Obamacare or some other horrific talking point before July 4.

The next 72 hours will decide if the richest country in the world will take health care away from its poorest citizens to give a small percentage tax break to its richest. To see what you can do to stop this cynical bill from reversing our society’s progress, read this guide from Indivisible. If you’re in the D.C. area, there will be a human chain in front of the U.S. Capitol on Wednesday at 5pm.