GOP should pull back from heartless health bill

The Republican leadership in the Senate, after devising in secret the proposed health care law that would replace the Affordable Care Act, continued to tweak it this week in search of votes.

Whatever the nature of these adjustments, the fundamental framework of the legislation can be expected to stay the same. It closely resembles the legislation approved by the Republican-controlled House of Representatives.

That framework eliminates access to health care for millions of economically vulnerable Americans in order to abolish taxes imposed on higher-income Americans to pay for the health care expansion during the administration of President Obama.

The result is that the Senate legislation would leave 22 million fewer Americans with health insurance by 2026 than is now the case under Obamacare, according to a Congressional Budget Office assessment released Monday. This is similar to the CBO assessment of the House version.

The Senate bill would begin to ration Medicaid, which was expanded under the ACA to extend government-paid health care coverage to millions of Americans. The 31 states, including Connecticut, that elected to expand Medicaid under the ACA would see their funding reduced in 2021, and capped after 2024.

In addition to reducing access to Medicaid, the Senate bill would provide less generous subsidies, which help working-class people afford health insurance. And it would be harder to get the subsidies. No one making more than 350 percent of the federal poverty level, about $42,000, would qualify for subsidies.

Older people, who have not yet qualified for Medicare, would pay more for their health insurance. Under the Affordable Care Act, insurers cannot charge older customers premiums that exceed three times what they charge their youngest customers. The Senate would allow premiums five times higher.

The savings realized by cutting Medicaid and reducing subsidies would be used to provide tax cuts — eliminating the taxes on investment income, on wages above $200,000 annually, on medical devices, prescription drugs and on indoor tanning that were used to pay for expanded health care under Obamacare.

The big cuts in Medicaid and in subsidies would decrease federal deficits by a total of $321 billion over a decade, the budget office said. The problem is that congressional Republicans and President Trump do not intend to use those savings to cut deficits, but instead to provide massive tax cuts aimed largely toward the rich in a rebranding of the failed trickle-down theory of economic growth.

Gone would be the exchanges created under ACA, which allowed consumers in the individual market to compare plans and pick the best suited for them. The exchanges have not worked as planned, with premiums increasing and participating insurers dropping. Part of the blame, however, goes to the unwillingness of Republican lawmakers to consider any repairs that might improve the exchanges and help Obama care exceed.

The Senate bill would provide tax credits to help individuals buy insurance, but the bottom line is that millions fewer Americans would manage to get access to coverage.

In terms of promises of lower premium rates, it is hard to see the Senate or House health bills achieving them. Large companies would no longer be obligated to provide their workers with insurance coverage. Eliminated, too, would be the mandate that individuals must purchase insurance.

Yet insurers would still be prohibited from denying coverage to individuals with pre-existing medical conditions. The result would be millions of consumers waiting until they were sick to get insurance, a reality sure to drive premiums higher for all, not lower them.

Readers need to again be reminded that the Senate legislation, like the House version, in no remote way resembles the “insurance for everybody” promise repeatedly made by Trump during the campaign.

“You will end up with great health care for a fraction of the price,” said Trump at one Las Vegas rally.

With its tattered remnants of Obamacare and its heartless approach in cutting access to care to the poor and elderly, the bill is having trouble attracting the votes of both free-market purists and of moderates in the Republican caucus. Best case scenario is that it dies and Congress does what Americans really want — seek bipartisan cooperation to solve the health care problem.

The better solution is to toughen the requirement that everyone obtain health insurance but cap what young people can be charged for it, allow interstate insurance sales (as Trump promised), and provide a public option on the exchanges to boost competition and drive down premiums.

If Republicans choose instead to continue in their present manner, they will pay a stiff political price.