The Trumpcare Disaster

The House speaker, Paul Ryan, and other Republicans falsely accused Democrats of rushing the Affordable Care Act through Congress. On Thursday, in a display of breathtaking hypocrisy, House Republicans — without holding any hearings or giving the Congressional Budget Office time to do an analysis — passed a bill that would strip at least 24 million Americans of health insurance.

Pushed by President Trump to repeal the A.C.A., or Obamacare, so he could claim a legislative win, Mr. Ryan and his lieutenants browbeat and cajoled members of their caucus to pass the bill. Groups representing doctors, hospitals, nurses, older people and people with illnesses like cancer opposed the bill. Just 17 percent of Americans supported an earlier version of the measure, and Republicans have made the legislation only worse since that poll was conducted. Neither Mr. Trump nor Mr. Ryan seemed bothered by this overwhelming criticism of their Trumpcare bill, the American Health Care Act. They seemed concerned only about appeasing the House Freedom Caucus, the far-right flank of their party.

Mr. Trump in particular has been spreading misinformation and lies about health care, arguing that the legislation would lower costs while guaranteeing that people with pre-existing health conditions could get affordable health insurance. It would do the opposite. Here is what the bill actually does:

Takes a machete to Medicaid. The bill would cut $880 billion over 10 years from Medicaid, the program that provides health care to about 74 million poor, disabled and elderly Americans. That’s one-fourth of its budget. As a result, 14 million fewer people would have access to health care by 2026, according to a C.B.O. analysis of the earlier bill, which contained similar Medicaid provisions. The cuts would also hurt special education programs, which receive about $4 billion from Medicaid every year.

Slashes insurance subsidies. It would provide $300 billion less over 10 years to help people who do not get insurance through employers and have to buy their own policies. This would hurt lower-income and older people the hardest. For example, a 60-year-old living in Phoenix and earning $40,000 would have to pay an additional $12,370 a year to buy a policy, according to the Kaiser Family Foundation. Many people who find themselves in this situation would have no choice but to forgo insurance.

Eliminates the individual mandate. Many people hate that the A.C.A. requires people to buy health insurance or pay a penalty. But without the mandate, fewer younger and healthier people would buy coverage. This would lead to what health experts call a “death spiral” as insurers raise rates because they are left covering people who are older and sicker, leading to even more people dropping coverage. Eventually, companies could stop selling policies directly to individuals in much of the country.
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Guts protections for people with pre-existing conditions. An amendment by Representative Tom MacArthur of New Jersey would allow states to waive the requirement that insurers sell policies to people with prior health problems and not charge them higher rates. The chief executive of Blue Shield of California said the bill “could return us to a time when people who were born with a birth defect or who became sick could not purchase or afford insurance.” Republicans say they will require that states with waivers offer high-risk pools and find other ways to help treat these people. The bill offers $138 billion over 10 years to help states pay for such programs. Experts say this is far too little; Larry Levitt of the Kaiser Foundation estimates it would take at least $25 billion a year.

Makes insurance less comprehensive. The bill would also let states waive a requirement under Obamacare that insurers cover a list of essential services. This means people in some places might not have access to maternity care or cancer treatment. This provision could also hurt people who get insurance through work, because federal regulations allow employers to opt into the rules of any state for the purposes of determining annual and lifetime limits on coverage, according to an analysis by the Brookings Institution.

Defunds Planned Parenthood. Republicans have included a provision that takes federal money away from the organization, which provides birth control, cancer screenings and other health services to 2.5 million people, mainly women. About 60 percent of people who use Planned Parenthood depend on government programs like Medicaid.

Despite this catalog of the bill’s horrors, many Republicans have embraced it so they can claim they fulfilled their promise to repeal Obamacare. They aren’t bragging that the bill would reduce tax revenue by $880 billion over 10 years, according to the C.B.O. A vast majority of those tax cuts would go to wealthy Americans.

The bill now moves to the Senate, where several centrist Republicans are opposed to it. The best hope for defeating this legislation rests with lawmakers like Shelley Moore Capito of West Virginia, Susan Collins of Maine, Lisa Murkowski of Alaska and Rob Portman of Ohio. But Mr. Trump and far-right groups will put tremendous pressure on them to pass this dreadful bill or something similarly terrible. The health of millions of Americans is now in their hands.



[The New York Times]