The Senate’s sick scheme

They did it: Senate Republicans managed to draft a health-care-reform bill worse than the reviled American Health Care Act that got through the House last month. The legislation, which hatched Thursday after weeks in a secret incubator, isn’t that far off from the House-passed plan, which the Congressional Budget Office predicted would shred health coverage for 24 million Americans.

But where it differs, it tends to deal even more severe blows to Americans on the lower rungs of the income ladder.

In the House bill, cuts to Medicaid — the federal health-care program for the poor, which covers one in five Americans — were deep. In the Senate version, they’re deeper, instituted via capped grants that shift costs, by the billions, to states.

Those cuts are especially cruel at a time when an aging population will increasingly depend on Medicaid, including for nursing home care, and when states need Medicaid to combat opioid addiction.

So much for Donald Trump’s campaign pledge not to cut Medicaid. So much for his urging the Senate to deliver something with more “heart” than the “mean” House bill.

The Senate bill undercuts the private market, too, by being more reckless than the House bill in one major respect.

In one of its few doses of sanity, the House bill encouraged people to pay into insurance even when healthy by retaining a market-based version of the Obamacare individual mandate: Individuals who went without insurance for an extended period had to pay a higher premium.

The Senate has no such mechanism, but outlaws denial of coverage for people with preexisting conditions. Which creates a perfect incentive for free riders to stay out of the market until they get sick, then buy in without penalty. That is simply idiotic.

Little wonder premiums and deductibles would both rise on the individual market — more broken Trump promises.

Meanwhile, tax credits for middle-income Americans and the elderly shrink substantially from the current Obamacare subsidies.

Where does all the money go? To tax cuts, primarily benefiting businesses and the wealthy. That includes a retroactive capital-gains tax and a tax break for the highest-paid insurance CEOs.

Next week, the Congressional Budget Office will formally score the Senate bill. But the verdict is in: This is a boon to the healthy and wealthy and an insult to the sick and poor.