Andy Slavitt is pretty familiar with government healthcare laws, as he ran Medicare, Medicaid, and the ACA for President Obama. He is currently a senior advisor at the Bipartisan Policy Center, a “think tank that combines the best ideas from both parties to promote health, security, and opportunity for all Americans.”

Today, he did two Twitter threads on the Senate version of the AHCA (Trumpcare). We have collated these for you into regular bulletted text, for easier reading. So, please read, then share. Then call!

—Thread One—

As the Senate bill is released this morning, a few essential things…

  • The Senate bill takes horrible cuts to Medicaid & makes them worse. Do not accept the goal of making them 10% better. That’s the strategy.
  • The cap structure proposed by the House & made worse by the Senate will permanently harm the health of children.
  • McConnell intends to release a final version of the bill (right?) before the vote. You won’t be looking at the final bill this AM.
  • The Senate bill needs to be compared to current law, not the House bill or any changes made to this bill.
  • The Senate bill also plays out Trump’s game of sabotage by making clear that the law will only be enforced paying CSRs if the bill passes.
  • In addition to all of this, McConnell is planning to buy votes as needed at the end with other window dressing changes.
  • At the end, the bill will be VERY close to the House bill.
  • Senate bill will end Medicaid as we know it, end pre-ex protections, drive up premiums particularly for older ppl. That won’t change.

—Thread Two (after bill was released)

The Senate discussion bill is out. It’s the ugly step-sibling of the House bill. Here is the bill:

  • Point 1: The ACA is not repealed. Health care for poor people, kids, the disability community and seniors is.
    • The ACA income based tax credits stay– due to Senate rules. They just get bulldozed. More accurately, the people receiving the help do.
    • What’s a conservative to do? They hate the tax credits. But they do demolish what an insurance company needs to do. Which they love.
    • Older people will be charged much more. Ppl over 350% of poverty won’t get any support. Insurance will only cover 58% of someone’s needs.
    • Millions of families lose coverage. Those with insurance will get a lot less. Maternity, mental health, cancer treatments, not required.
    • Insurers won’t cover expensive HIV & cancer meds if they are the only ones. Coverage will devolve. That’s the point, not a side effect.
  • POINT 2: The main event in the Senate bill is the destruction of Medicaid. Far, far worse than even the House bill.
    • Eligibility for exchanges would begin at 0% of FPL. This means states could eliminate Medicaid & put people in the exchange w no help.
    • Medicaid’s cuts of 25% in the House increase much more in the Senate. Hundreds of billions more cuts.
    • Medicaid cuts spike further in 2025. The year baby boomers turn 80. And Medicaid pays half of nursing home care in the country.
    • This bill is awful for anyone planning on aging. Age tax, nursing home cuts, robbing Medicare Trust Fund.
    • For seniors, this bill is the opposite of our commitment to Americans as they age or get ill.
    • The Senate bill hurts kids by putting a capped price tag on their lives too.
  • POINT 3: There is 1 sacrosanct part of the bill. The giant tax cuts for wealthy, insurers, pharma & other corporations are intact.
  • POINT 4: Even with all of this, this is not the bill.
    • When Trump says he wants Trumpcare not to be “mean” he wants the Senate bill to be compared to the House bill not current reality.
    • So they made this bill worse to make it “better” and “worse” as necessary with a bill that will be released at the very end.
  • POINT 5: Bill violates every criticism from Rs over last 7 yrs:
    • Higher deductibles – lower coverage – gifts to insurers – cuts to middle class.
    • (More) Fewer docs covering Medicaid – higher premiums – hurts rural – hurts opioid treatment.
    • There are dozens more blatant contradictions.
    • Hopping now into conversations. More to come as we learn more.

—Thread on Gutting of Medicaid—

NEW*: The Senate bill is much worse: 1332 waiver allows much more 2 be waived than Mccarthur amendment does.

READ THIS: it’s amazing. Medicaid could get decimated using waiver process. With incentives to. You should be in shock. And then action.

Even more on what could be waived by states in the Senate bill.


Bruce Maples
Bruce Maples has been involved in politics and activism since 2004, when he became active in the Kerry Kentucky movement. He has been President, Vice-President, and Treasurer of the Metro Democratic Club, and has served on the Democratic Party Executive Committee in Louisville. He began blogging in 2004, and currently operates two personal blogs ( and He founded Forward Kentucky in the wake of the state elections in 2015, and expanded it in the summer of 2016. He has lived in Louisville since 1992 with his wife and two sons.


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