Viewpoints: Why Senate should go back to drawing board for health bill


Senate Republicans promised to write a different – if not better — health care bill after the House delivered its widely criticized attempt at an Affordable Care Act repeal in May.

Instead, the Mitch McConnell-led Senate proposes much of the same: a bill, named the Better Care Reconciliation Act, that would provide tax breaks for the wealthy and would hit even harder than the House version those most in need of medical insurance, including rural America, people between the ages of 50 and 60, the sick and the poor.

“Meaner.” That’s how one U.S. senator accurately describes the Republican health care bill released by the Senate last week.

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This editorial board still contends that the Affordable Care Act, known to many Americans as Obamacare, is broken and needs to be fixed. Just as with the House version, the Senate bill does little to address the Obamacare’s biggest problems, including its shrinking marketplace and increased premiums. No wonder this latest GOP proposal is meeting the same resistance as the first one.

Several polls show many health care organizations and most Americans also disapprove of the Senate bill. Polls conducted by NPR/PBS Newshour/Marist, Fox News and Kaiser Family Foundation found most Americans – between 54 and 55 percent — have an unfavorable view of the bill. There’s plenty not to like.

Under the Better Care Reconciliation Act, 15 million more people would be uninsured next year compared with current Obamacare law, according to an analysis released Monday by the nonpartisan Congressional Budget Office. The analysis estimates more than 22 million people would be without health insurance by 2026 under the Senate bill. That figure is only slightly lower than the 23 million more uninsured that the House version would create, according to the budget office.

That’s because, the Senate bill — like the House version — would replace Obamacare’s income-related tax credits with age-based tax credits. Today, under Obamacare, healthy young people pay more in premiums, allowing older, less-healthy people to pay less. Under both GOP plans, the elderly and the sick would pay more.

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As many as 1.3 million Texans who gained coverage under Obamacare – most of them enrolled in Republican districts – would be at risk of losing their health care coverage under the Senate plan.

Structural changes to the nation’s economy make adults who are close to — but not of — retiring age among the most vulnerable under the Republican plans. Too young for Medicare, this population group needs to remain on the payrolls for insurance coverage. But increasingly, American employers are pushing out people between the ages of 50 and 60 from the workforce.

The Senate bill makes accessing health care more difficult for this population. Consider that under the Senate plan, a 60-year-old with a $40,000 income in Travis County will pay after tax credits a $7,700 premium, or 19 percent of his or her income. Under Obamacare, the premium is $4,080.

For individuals in rural Texas, those numbers are even higher. Take for instance our 60-year-old neighbors in Tom Green County living on a $40,000 income. Under the Senate plan, they would pay — after tax credits — an $11,820 premium, or 30 percent of their income. That’s $7,740 more than the Obamacare premium.

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Making the Senate plan meaner than House bill is its proposal for even bigger cuts to Medicaid, a measure that leaves rural communities and the poor everywhere more vulnerable. Instead of splitting the cost of Medicaid with states, the Senate, like the House, proposes a block grant program that caps the amount of federal funding states receive. The Senate plan would cut Medicaid spending by as much as $772 billion — compared with $119 billion for the House’s version — in the coming decade, leaving states to pick up more of the tab.

As of February, more than 4.5 million Texans — including more than 3 million children — were enrolled in Medicaid, according to Texas Health and Human Services Commission data.

Leaving healthcare to the Texas legislature stacks the odds higher against the state’s sick and the poor. Historically, Texas — where Medicaid is the largest source of federal funding, according to the Legislative Budget Board — ranks nationally among the lowest in health care accessibility and affordability, according to a variety of studies.

Cuts to Medicaid put rural hospitals — which serve a large population of sick, older and poorer patients — at risk of closure. With closure comes loss of jobs and a lower quality of life for affected communities, note experts like Anne Dunkelberg, associate director of the Center for Public Policy Priorities. The Senate bill would threaten the closure of even more, Dunkelberg told us.

On the positive side, the latest GOP health care proposal would allow people to stay on a parent’s health insurance plan until age 26, just as with Obamacare. To some degree, it would eliminate the individual mandate that requires health care coverage.

Duplicating the House’s efforts, the Senate plan would reduce the federal deficit by $321 billion over the next 10 years. But those savings, as we’ve said before, would quickly evaporate as costs shift to local taxpayers to pay the tab for uninsured people crowding emergency rooms or clinics.

Except for the fact that under the Senate plan, the poor and those who need insurance would pay more, there’s little difference in the House and Senate versions. That is not progress.

We urge Republicans again to turn their attention to repairing the ACA and give Americans an affordable way to care for themselves and their families.



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