The Senate must not have heard President Trump's description of the House's proposed Obamacare replacement as "mean" because the legislation finally revealed by the upper chamber Thursday generally duplicates the worst parts of a bill that threatens Medicaid coverage for millions of Americans.
Of course, it's hard to believe anything Trump says. He has repeatedly called the Affordable Care Act a "disaster." But if that's so why is an insurance company with ties to his family expanding its market participation in the ACA exchanges?
Insurance startup Oscar, cofounded by Josh Kushner, brother of Trump son-in-law and aide Jared Kushner, announced this week that it will start selling ACA plans in Ohio, Texas, Tennessee, and California, re-enter New Jersey's market, and keep selling plans in New York. "We're confident that, when the dust settles, the market for health insurance will stabilize in time for 2018," said Oscar CEO Mario Schlosser.
It's nice that someone can be that confident. The governors of states that expanded Medicaid under Obamacare are probably experiencing a different feeling. Now that they have seen the Senate bill, they know it too would phase out the extra money the ACA provides to states that expanded Medicaid eligibility. That includes Pennsylvania and New Jersey.
Also like the House version, the Senate bill caps federal funding for Medicaid. States making hard budgetary choices are unlikely to fill the breach. Imagine the impact on states like Pennsylvania with growing populations of seniors who depend on Medicaid not only to pay medical bills but also their housing in assisted living facilities and nursing homes.
The Senate bill would continue the Obamacare subsidies to buy health insurance, but lower the income levels used to qualify for the tax breaks. Even if the subsidies continue, by eliminating the linchpins of the ACA, the individual and employer mandates, both Republican bills would remove the key incentives to get more young, healthy, working Americans to buy medical insurance.
Without the mandates stick to accompany the tax-credits carrot, insurance companies will again have to raise premiums to cover a disproportionate number of policyholders with health problems while other potential customers keep spending their money on movie tickets and the latest smart phone.
Republicans intent on killing Obamacare don't intend to let the consequences stand in their way. Even as the Senate bill cuts Medicaid — a program serving one in five Americans — the legislation would also repeal almost all the taxes being used to pay for ObamaCare's coverage expansion. "The top one tenth of the one percent would receive thousands upon thousands of annual tax cuts while some individuals with disabilities lose coverage. That is obscene," said Sen. Bob Casey, (D., Pa.).
Obscene is also a good word to describe the secretive process that Senate Republicans have used to write their legislation. Unlike with Obamacare, there have been no committee hearings, no public debate. Just as it was with the House bill, the nonpartisan Congressional Budget Office has not been given time to assess the Senate legislation, which may be voted on next week.