For Americans who are both wealthy and healthy — and especially young — the U.S. Senate's health care bill, unveiled yesterday, might not be very concerning. For just about everyone else, the sweeping changes to Medicaid, to subsidies, to the individual market and to coverage standards carry some hefty consequences if the bill passes.
And that's a big if. In a couple of weeks, the Senate bill might be moot and Congress may have to start all over if Republicans can't get their members on the same page. At least four conservative GOP senators, including Texas's own Ted Cruz, say they won't vote for this draft of the bill because they don't think it goes far enough to repeal Obamacare. That's more than enough senators to kill the legislation, as Republicans hold only a two-seat majority in the Senate. Meanwhile, Democrats are reeling at the damage they believe the bill, drafted in secrecy by Senate Majority Leader Mitch McConnell, would cause the country's most vulnerable citizens.
With significant tax breaks for the most affluent Americans, the bill, called the American Health Care Act, also would shrink the Medicaid budget by billions, therefore hurting the poorest.
In Harris County, where more than 600,000 people depend on Medicaid for health care and where another 740,000 are uninsured, any hurdles affecting access to care are particularly concerning. Especially for a public hospital system already spending $648 million a year — nearly half its budget — on uncompensated care.
So who has the most to lose?
1. The elderly and the aging. University of Houston Professor Seth Chandler, who specializes in health and insurance law, said that with all the focus on how the GOP health bill significantly reduces Medicaid funding, the effects on Medicare have become something of an afterthought. "People say, oh, [the health care bill] is a tax cut for the wealthy — which is true; it is. But this bill eliminates some of the taxes that are directly earmarked for Medicare," Chandler said, "and Medicare wasn’t in good shape to begin with. So one thing people should be quite concerned about is the stability of Medicare."
People aren't eligible for Medicare until age 65 — but it's also the 55-64 age range that could be in jeopardy under the Senate bill. While under the Affordable Care Act, President Barack Obama's health plan, insurance companies are not allowed to charge an older person more than three times what they do a younger person, under the Senate bill, insurance companies can charge older people five times more. So in other words, once Americans turn 55, their health care becomes significantly less affordable. And by the time middle-aged Americans are feeling the burn in their sixties and seventies in the coming decades, Chandler said, "the people who passed that law, way back in 2017, will be long gone, and won’t be held accountable. It’s like pension funding: Once you fall behind, it’s very hard to catch up."
2. The working poor. The GOP bill seeks to phase out the Medicaid expansion funding under Obamacare starting in 2021 and through 2024. In a way, Chandler said, Texas has the advantage here: It is one of 19 states that chose not to expand Medicaid, and so it will feel the sting of this cut less than other, more liberal states might. Still, the overall Medicaid budget is shrinking too, which translates to states having less money to fund it, and fewer people to give it to. For people who depend on it, this can't be good. This includes almost two-thirds of people in nursing homes. On top of that, the bill would eliminate subsidies to help low-income people cover out-of-pocket costs and deductibles starting in 2019.
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3. People who need mental health treatment. Mental health care was considered an "essential health benefit" under Obamacare. This bill gets rid of that. States can request a waiver that releases insurance companies from being required to cover those essential benefits, including emergency care and maternity care, and Medicaid wouldn't have to do it either. So if you, like nearly one-fifth of the country, depend on mental health treatment in your day-to-day life, the Senate bill puts you at the mercy of state leadership in hopes that legislators are thoughtful enough not to do away with this essential care.
4. Women who rely on Planned Parenthood for reproductive health care. Surprise: Republicans want to defund Planned Parenthood. That would leave the care provider short half a billion dollars and leave more than 2.5 million women without access to affordable birth control, reproductive exams and STI treatment.
With all the internal disagreement among Republicans about whether the bill is as restrictive as possible, however, Chandler said the country may be dealing with "the embers of Obamacare" for a while longer. Senate Majority Leader Mitch McConnell wants to put the bill on the floor for debate by next week — but whether he can garner the 50 votes needed to pass it is uncertain with the dissent coming from other conservatives.
"We seem to have deadlocked," Chandler said, "because being a Republican is not a monolithic characteristic — there’s a whole spectrum, and they seem unable to subordinate their differences and come up with a unified plan, and the Democrats don’t appear to be willing to work with the less conservative Republicans to modify the Affordable Care Act. Neither side can win: We’re sort of in a World War I trench warfare situation."