Senate Republicans released a revised version of their TrumpCare bill. It’s their best attempt at keeping at least 50 of their 52 members on board. But the biggest so-called “fix,” the Ted Cruz amendment, actually makes the bill WORSE. And nothing in this revised version of TrumpCare makes up for enormous losses in coverage or the dramatic cuts to Medicaid funding. Bottom line: TrumpCare still is terrible for the American people and your Senator should absolutely oppose it.
What didn’t change is what makes the bill worst of all
It still destroys Medicaid as we know it. Today’s version of TrumpCare still cuts Medicaid dramatically, ending the expansion and radically transforming it to a capped system. Medicaid caps will lead to tradeoffs about who receives care and who doesn’t, hurting low-income families, people with disabilities, and older Americans the most. Twenty percent of Americans rely on Medicaid. These Americans deserve better, especially considering that these huge cuts to Medicaid are made in order to give massive tax breaks to insurance companies and drug manufacturers, including the drug makers that are fueling the opioid epidemic.
Costs for patients will still go up. This is because the bill still lowers the percentage of costs plans are required to cover, and bases the level of help affording insurance through tax credits on the newly-lower quality plans. Currently, plans have to cover at least 70% of the health care costs incurred by a consumer. TrumpCare drops that number to 58%, meaning consumers could see their out of pocket costs go up for things like co-pays and prescriptions. It will be much more expensive for you if you get sick or injured.
At the same time, TrumpCare reduces help to consumers buying insurance. Current law provides many Americans tax credits that offset the cost of their monthly premiums. The tax credits are available to anyone who makes less than 400% of the Federal Poverty Level. (In 2016, that is about $48,000 for a single person.) The Senate version of TrumpCare lowers that threshold to 350%—meaning higher premiums for those families.
Here are their “fixes”—and why they don’t work
The Cruz Amendment. TrumpCare includes the Cruz Amendment, which would allow insurance companies to sell plans that have fewer benefits and patient protections, as long as they sell just one plan that complies with the ACA requirement to cover essential health benefits. This policy separates people into two systems of insurance: one for healthy people, and one for people who are sick, expect to become pregnant, or had a health issue in the past. That is an insurance market doomed for failure—it would create a classic death spiral. In fact, for all Republican talk of the failure of Obamacare, health insurers have said this proposal is “unworkable.”
Health savings accounts. HSAs are of little or no value to most of the people who would lose coverage if Obamacare is repealed. That’s because to take advantage of a health savings account, you have to have enough money to deposit a meaningful amount of savings into them. HSAs only benefit those who can afford high-deductible plans to and plow extra savings into them. This is actually an extremely lucrative tax shelter for the wealthy, who under TrumpCare would be able to double the amount of money they can stash in an HSA annually.
Stabilization slush fund. TrumpCare includes a few billion dollar “stabilization” (read: slush) fund that Republicans say will be spent to offset all of the bill’s terrible effects. This bill adds a few billion more, but it’s largely a waste of money. First, the existence of this fund is like robbing someone of $100 and giving them $10 back for their trouble. Second, it’s not nearly enough money to offset the gutting of Medicaid, tax credits, and consumer protections. And the fact that the CBO scored the bill, slush fund included, as kicking 22 million off insurance demonstrates how little it does. Third, there’s not much oversight as to how states could use this money. Odds are many states will use their minimal share of the fund to benefit pet projects and special interests instead of helping those most in need.
Mitch McConnell may try to add even more money to the slush fund to try and win over more votes, but know that no amount he would add will make up for the massive cuts to health care spending in this bill.
Opioid funding. McConnell added funding in the bill in order to bribe Senators in states ravaged by the epidemic, like Sen. Portman (OH-R) and Senator Moore Capito (WV-R), for their vote. But this is woefully inadequate to address the opioid crisis and is not a comprehensive solution.
In 2015, more than 33,000 Americans died from an opioid overdose, and more than two million had an opioid use disorder. No matter how much additional funding is added, TrumpCare still ends the Medicaid expansion and lets states waive essential health benefits. Though $45 billion may sound like a lot of money, it pales in comparison to the amount of guaranteed funding and comprehensive benefits available to fight opioid addiction under current law, which this bill seeks to undo.
Stated simply, the single most important thing Congress can do to address the opioid crisis is to preserve Medicaid, which is by far the most effective tool we have in the fight against addiction. Everything else is window-dressing.
The bottom line
McConnell isn’t interested in fixing health care—he wants 50 votes and a political win for his party. As we wait for the official CBO score, your advocacy matters immensely. No matter where you live, call your senators. Make those office visits. Use our resources, including call scripts and explainers on McConnell’s "fixes" here: http://www.indivisible.org/resources/healthcare. And if you live in one of our TrumpCare Ten states, we've got even more info and daily call scripts for you here: https://www.TrumpCareten.org.