But the bill would partly roll back popular consumer protections that are required under Obamacare. Insurers would be free to offer skimpy, no-rules plans that could exclude people with prior illnesses, strip out major benefit categories, like prescription drugs, and limit the total amount of care they will cover. In exchange, carriers would also need to offer a set of more comprehensive plans, and the federal government would set aside a fund to help make those plans affordable for sicker Americans.
The Senate bill would still make fundamental changes to Medicaid, which covers poor and disabled Americans, including two-thirds of all nursing-home residents. And it would still ask middle-income Americans to pay a larger share of their incomes for health plans with higher deductibles. Moderate Republicans had asked for changes that would make the bill more generous to poor and elderly Americans who would lose out, and those requests were largely ignored.
But the bill eliminates big cuts in payroll taxes and investment taxes for the wealthy, blunting one of the most resonant Democratic lines of attack against the effort. Still on the winners ledger: tanning salons, medical device manufacturers, pharmaceutical companies and health insurers, which all still would get a tax cut.
The revision with the biggest implications for consumers is the Cruz amendment. Two of the biggest insurance industry groups, which have been largely silent as the health debate has played out, spoke out Wednesday in opposition to the amendment. America’s Health Insurance Plans and the Blue Cross Blue Shield Association indicated that they did not wish to operate in the regulatory landscape created by the bill, which they said would split the insurance market in two.
Even Worse: New Senate Health Care Bill
Republican leaders in the Senate have accomplished what seemed impossible a few weeks ago: They have made their proposal to destroy the Affordable Care Act even worse.
On Thursday, the majority leader, Mitch McConnell, produced revised legislation that could effectively make it impossible for many people with pre-existing medical conditions to afford the treatment they need. Even people who are healthy now could find themselves unable to pay for comprehensive health insurance when they become sick. In addition, the bill still includes drastic cuts to Medicaid, which provides care to about 70 million people. In essence, the Senate leader just swatted away the concerns of Republican senators and governors who questioned those cuts.
The initial version of the Senate bill would have taken health insurance away from 22 million people, the Congressional Budget Office found. Experts say that the number could rise once Mr. McConnell’s changes are factored in.
The Cruelty And the Fraudulence
The original Senate bill got a lot of justified bad press for slashing Medicaid while offering big tax cuts for the rich. So this version rolls back some though by no means all of those tax cuts, which sounds like a concession to moderates.
At the same time, however, the bill would allow people to use tax-favored health savings accounts to pay insurance premiums. This effectively creates a big new tax shelter that mostly helps people with high incomes who (a) can afford to put a lot of money into such accounts and (b) face high marginal tax rates, and hence get big tax savings.
So this is still a bill that takes from the poor to give to the rich; it just does so with extra stealth.
Still, this tax shuffle does give McConnell a bit more money to play with. So how does he address the two big problems with the original bill — savage cuts to Medicaid and soaring premiums for older, less affluent workers? He doesn’t.
Aside from a few tweaks, those brutal Medicaid cuts are still part of the plan — and yes, they are cuts, despite desperate Republican attempts to pretend that they aren’t. The subsidy cuts that would send premiums soaring for millions are also still there.
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And the conservative view has always been that Americans have health insurance that is too good, that they should pay more in deductibles and co-pays, giving them “skin in the game,” and thus an incentive to control costs.
So what we’re seeing here is supposed to be the last act in a long con, the moment when the fraudsters cash in, and their victims discover how completely they’ve been fooled. The only question is whether they’ll really get away with it. We’ll find out very soon.
