Twenty two million Americans will lose insurance if the Senate's draconian Trumpcare bill becomes law, according to an estimate released Monday by the Congressional Budget Office. Fifteen million Americans would lose coverage in the first year alone – including four million Americans who would lose the coverage they currently get through work.
The cuts under the Senate bill are bone-deep: Trumpcare axes $772 billion from Medicaid in the first decade. (The CBO projects more severe reductions in subsequent years, as the phased-in Senate cuts take full effect.) Subsidies for Americans buying individual policies are also slashed, by more than $400 million. "The average subsidy" for insurance buyers "under this legislation would be significantly lower than the average subsidy under current law," the CBO writes.
In short, the Better Care Reconciliation Act is a formula for worse health care in America. "For all the talk of the Senate dramatically changing the House bill, it's not much different," tweeted Andy Slavitt, who ran Medicaid and Medicare under president Obama. "Except meaner."
Senate Republicans use the savings won by cutting the health care of the poor, disabled, elderly and middle-class to pay for $541 million in tax cuts favoring the wealthiest Americans. The Senate bill could also create $321 billion in deficit reduction, according to the CBO, roughly $200 billion more than the House bill.
The Senate Trumpcare bill is particularly cruel to women. By cutting federal support for Planned Parenthood, the CBO estimates, Trumpcare would leave many women without a health care provider – and increase unwanted pregnancies. The report estimates that "about 15 percent" of women who "reside in areas without other health care clinics or medical practitioners who serve low-income populations" would "lose access to care" under the Senate bill. Ironically, this cut to Planned Parenthood would increase dependency on government. Because Medicaid pays for about 45 percent of all births in this country, "the additional births stemming from the reduced access under this legislation would add to federal spending for the program," the CBO writes.
In the individual marketplace, Trumpcare would cause premiums to spike by 20 percent in the first year alone. In later years, premiums would shrink in comparison to Obamacare – largely because Trumpcare would steer Americans into lower-quality plans with higher costs at the doctor, hospital and pharmacy. "Most people" buying coverage under Trumpcare would face "higher out-of-pocket spending on health care than under current law," according to the report. Others would face financial ruin because Trumpcare again permits the sale of policies with annual and lifetime caps on benefits.
Unlike the House-passed version – which has age-based subsidies – Senate Trumpcare preserves the income-based structure of Obamacare. But the Senate bill dramatically shrinks the benefits. The bill hits older, middle-class Americans hardest. First, the legislation allows insurers to charge older customers higher premiums based on age. Second, it eliminates subsidies for Americans of modest means altogether.
Under Obamacare, a 64-year-old making $56,000 a year would pay about $6,800 for a "silver" (i.e., decent) health care plan in 2026. Under the Senate Trumpcare bill, the same 64-year-old would be forced to pay $20,500 in premiums, according to the CBO – shelling out more than a third of annual income for health insurance, before accounting for any costs of care or drugs.
