The Senate version of Trumpcare dropped today, and it is even worse than we thought possible. The bottom line? Higher premiums for less coverage, millions lose health insurance, pre-existing conditions priced out of reach, and Medicaid gutted.

And for what? To give tax breaks to the 1%, and giant tax breaks to the top of the 1%.

What follows is a quick summary of the losers and winners, along with why. Note that this is NOT a complete list. Also note that many of the provisions do not kick in until after the midterms in 2018, or even later (after 2020). So, we have to talk about these NOW, so that people know they are in the bill.

Winners

  • The wealthy
    • The Senate bill includes $1 trillion in tax cuts for the wealthy.
    • Included is a repeal of a 3.8% investment tax that was put in place to help pay for Obamacare. If you are a person who makes the bulk of your income through investments, this can be a windfall for you.
    • In fact, Chris Hayes notes that for someone making $1 million a year, this tax cut alone would be more than the median annual income of everyone else.
  • The insurance companies
    • Insurance companies will no longer be required to cover the “essential health benefits” in their plans.
    • Insurance companies will be able to charge more for less insurance, thus increasing their profits even more.
    • Insurance companies will now get to deduct from their taxes an extra $500,000 of CEO income.
  • Large companies
    • Large companies will no longer be required to offer health insurance to their employees, and many will choose not to, thus throwing their employees into an individual market already roiled by the Trump administration’s refusal to pay the expected subsidies to insurance companies.

Losers

  • Everyone who currently has insurance, including employer-provided
    • You now have lifetime caps on spending, even if your insurance is provided by your employer. So, get cancer, and you could run out of insurance.
    • Pre-existing conditions are still covered (although there is language that may get around that), but insurance companies are allowed to raise rates for people with pre-ex. Thus, it may be covered, but you may not be able to afford the coverage.
      • The answer proposed by Republicans is a return to high-risk pools, which have been shown not to work in the past. In addition, the bill’s funding for such pools is so inadequate as to be laughable, except for people who can only get insurance through such a pool, it is no laughing matter, but rather a matter of life and death.
    • Insurance companies are no longer required to provide the “essential health benefits” as part of every policy. So, even though you have insurance, that thing that used to be covered may no longer be. (Example: pregnancy)
  • The poor and middle class
    • Subsidies that were used by both the poor and the middle class have been lowered, and the income limits lowered as well, so less people will get them and the subsidies will be less.
    • Medicaid expansion is rolled back, so millions of people who were able to afford coverage will lose it again.
    • Medicaid is moved from an entitlement (covered no matter how big or small the number of people) to a capped amount (this is all the money you get, no matter what happens to costs or numbers). So, states will have to start limiting both who is covered and what is covered.
    • States can also apply for various Medicaid waivers, including (according to some) not even offering Medicaid at all.
    • And, just for additional cruelty, the Trump budget cuts Medicaid even more than this bill does.
  • The elderly
    • Obamacare (the ACA) only allowed insurance companies to charge older persons three times what they charge younger persons. Trumpcare changes that to five times as much. So, premiums for people over 50 are going to go up, sometimes dramatically.
    • Many, many senior citizens use Medicaid to pay for nursing home and other forms of extended care. With the cuts to Medicaid, that coverage will either be much less or non-existent.
  • The addicted
    • In the midst of the opioid crisis, the Senate bill only provides funding for addiction treatment for one year.
    • In addition, the amounts have been lowered.
    • And, with the cuts to Medicaid, as many as 2.8 million Americans with substance abuse disorders with no treatment.
  • The mentally ill
    • Treatment for mental health issues was one of the “essential health benefits” that had to be covered under Obamacare. Under Trumpcare, such coverage is no longer required, so insurance companies can once again refuse to cover it.
  • The blind and disabled
    • About 34 percent of Medicaid spending went to blind and disabled persons in 2015. With Medicaid slashed, those persons will get less coverage, or possibly no help at all.
  •  Women
    • As mentioned above, insurers are no longer required to include maternity coverage in their policies. Thus, we will return to the days of the “pregnancy rider” being added to a policy, for a substantial fee. And, if you don’t have such a rider and get pregnant anyway? Too bad – you get to pay for it all yourself out of your own pocket.
    • And, as expected, the bill completely defunds Planned Parenthood, even though the Federal funds were used for cancer screenings and birth control. Result? More unplanned pregnancies, and probably MORE abortions. (Was that the result Repubs wanted?)
  • Children
    • Pediatric services were one of the “essential health benefits” that had to be included in all plans. Now? Not so much.
    • And, a high percentage of children receive their health care through Medicaid, especially with the expansion. With Medicaid gutted, millions of children will receive no health care, including preventive care. Can you say “lost generation” when it comes to health? Watch for life expectancy to go down across the board due to lack of health care for our children.
  • Hospitals
    • As many as 24 million Americans could soon lose their health insurance. But, they are still going to need health care. Thus, hospitals are going to see a steep rise in their uncompensated care – enough in some cases to cause the hospitals to close.
    • In addition, many hospitals in rural areas depend on Medicaid payments to keep the doors open. With the cuts to Medicaid, large swaths of rural America could see their only local health care facility close.
  • The desperate
    • There is some speculation that, with the move to block grants and other forms of “replacement” health care funding, desperate people may turn to for-profit companies that will spring up promising to “get you the coverage that you deserve.” Much like the for-profit colleges that appeared to take advantage of Pell grant monies, these scam artists will prey on persons grasping at any straw to provide the health care they need.

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It seems impossible that any public servant or elected official could vote for a bill that harms so many, in so many ways. But, unless there is an unprecedented hue and cry from voters, this bill in some form will pass the Senate and House and be signed by President Trump, perhaps before July 1.

Let us pledge ourselves to raise that hue and cry, by whatever means possible.

–30–

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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 (BruceMaples.com and brucewriter.com). 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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