Well, it’s here–and like waking up to coal in your stocking on Christmas morning–the GOP Senate Health Care Bill has plenty of unpleasant surprises. Nonetheless, Mitch McConnell is determined to rush this bill to a vote, before the July 4th holiday. This may be to limit the influence of home state voters on members like Rob Portman who are not considered certain “yes” votes on this heartless bill. That’s why it’s important to contact Senator Portman and ask him to vote NO on the Senate Health Care Bill.
In the rest of this article, you can find out more about the specifics of the Senate plan. (And remember, don’t fall for comparisons to the House bill: this bill needs to be compared to what exists now under the ACA!)
1. Medicaid Cuts
States like Ohio that expanded Medicaid would continue to receive federal funding until 2023, but funding will be reduced sharply 2021-2024, and it is very likely that the lack of federal funding will cause states–especially states like Ohio that have mandated balanced budgets–to end the expansion by 2025.
Regular Medicaid funding, apart from the ACA expansion, are on the chopping block too. The bill caps spending per enrollee per year. Certainly fiscal responsibility is not a bad thing, but unfortunately, individuals cannot control the health issues they are stricken with, nor can individuals do much to change the high cost of healthcare in this country–and there is nothing in this bill that really addresses that core issue. So, capping costs will inevitably lead to less care and more costs for those on Medicaid.
Though we are still waiting for the CBO score, it’s likely this bill, like the House bill will cut about $800 billion from Medicaid.
2. Essential Health Benefits and Lifetime Limits
Republicans claim that their bill will reduce premium costs and increase consumer “choice,” but what they really mean is that they are increasing insurance company choice. Under the ACA, insurers were required for the first time to offer plans that included a list of essential health benefits. For example, no longer could they sell women plans that did not cover maternity costs, or anyone plans that did not cover mental health costs.
Under the new bill, states can waive the essential health benefits guidelines, and that would allow insurers to create plans that offer very little coverage at all: they might be cheap, and that might encourage consumers to choose them, but those who do will be very sorry later if they end up with an unexpected injury or illness that is not covered.
States can also apply to waive the rule on imposing annual or lifetime limits. Remember what it was like before the ACA? When you would watch the calendar and hope you could hold out until the next year when your health benefits would reset? And those with catastrophic diseases who would hit their lifetime coverage cap were faced with the choice between financially ruinous further treatment or no treatment at all. This bill would allow states who waive the ACA ban on annual and lifetime limits to go back to these bad old days.
We don’t know what Ohio would choose to do, but again, if the state is strapped for funds (which is very likely), difficult decisions will have to be made.
3. Subsidies for Out-of Pocket Costs
Under the ACA, subsidies are provided to help people with lower incomes pay for their out of pocket health costs. The ACA pays subsidies to offset about 70% of people’s costs, but this bill reduces this amount to only 58%. This important difference would take effect immediately on passage of the bill and would affect lower income people this year.
After 2019, theses subsidies will be cut completely.
4. Increased Costs for the Elderly
Under the ACA, the elderly, who need more health services, can be charged three times more than younger people. Under this bill, just like in the House version, they can be charged five times as much.
5. No More Mandates
This bill repeals both the individual mandate and the employer mandate. Many people did not like the individual mandate, but as discussed previously, the individual mandate is a key ingredient to keeping costs down by encouraging enough young and healthy people to join the pool to distribute costs. In this new bill, there is no alternate incentive or idea for getting these people into the healthcare pool. Those who chose to stop their insurance because of this provision could find themselves uncovered when they really need it, and those left in the pool will see their costs rise, because the proportion of people in the pool who require more health care will increase proportionally, causing the insurance companies to increase rates to offset their expenditures.
Repeal of the employer mandate means, simply, that businesses can stop offering health coverage, leaving their employees out in the cold.
6. Tax Cuts for the Wealthy
The one constant principle in all of the GOP health care legislation, the only thing that all members seem to require is a huge tax cut for the wealthiest Americans.
The ACA was designed to be revenue neutral — that is, even though it provided more funding for healthcare, it did not increase the deficit because it paid for those funds with a tax increase (a mere 3.8% increase on the highest earners, in most cases). That’s how government should work: revenue is raised through taxes and spent on things that help everyone.
But for some reason, Republicans, who are very keen to control federal deficits, are also very much against raising revenue through taxes–at least, through taxes on the wealthy.
The repeal of the ACA taxes in this bill will mean a windfall for the riches families in America. The bottom 90% of Americans (those earning $208,500 and less) will receive a $0 tax cut from this repeal.
But the top 0.1 percent, whose annual income is almost $4 million, will get an average tax cut of $165,090.
(see more details of the comparison between the GOP bill and the ACA here from the New York Times.)
Conclusion: Complaints Made–Problems Unsolved
For years, Republicans have complained about the high premium and deductible costs of the ACA, some have even said that the ACA doesn’t cover enough people. They have pointed out, ad nauseam, that the individual ACA market is failing (of course they leave out the part about their sabotage of it).
This bill fixes none of those things.
- Repealing the individual mandate will weaken the individual markets further
- Cuts to Medicaid, repeal of the employer mandate, and waivers for states of important ACA protections will increase the number of people without coverage
- Costs will go up for pretty much everyone — the clear hike for the elderly is just one example
Tell Rob Portman to Vote NO!
It’s likely that there will be some amendments to tinker around the edges to allow waffling Senators like Rob Portman to claim some small victory and say “YES.” Tell him not to fall for that. Tell him you are watching and holding him accountable. Tell him to protect healthcare for Ohioans.
How to get in touch with Rob Portman
Sen. Portman has an office in Toledo, and every Tuesday at noon, constituents visit his staffers there. This is a good way to convey your opinions about these important healthcare topics.
Call or mail
Washington, D.C. Office
448 Russell Senate Office Building
Washington, DC 20510
420 Madison Avenue
Toledo, OH 43604
Toll-Free: 1-800-205-6446 (OHIO)