By Jeff Kirkpatrick
UPDATE July 14, 2017: Trumpcare 3.0 has arrived. See, “Trumpcare 3.0: From Bad to Worse”
The revised Senate Republican version of Trumpcare was released on June 26, 2017; it is three pages longer than the previous version. This is still more accurately described as a TAX CUT bill disguised as a healthcare bill. A copy can be found here:
“Senate Healthcare Discussion Draft [Revised], H.R. 1628”, June 26, 2017 (145 pages)
The first version of the Senate Republican’s healthcare bill was 142 pages and a link to it is here: “Senate Healthcare Discussion Draft, H. R. 1628”, June 22, 2017 (142 pages)
“Twenty-two million fewer people would have health coverage over the next 10 years under legislation that Senate Republicans aim to bring to the floor for a vote this week, according to the Congressional Budget Office.”.
The CBO Report: “Cost Estimate of H.R. 1628 Better Care Reconciliation Act of 2017,” by Congressional Budget Office (CBO); June 26, 2017 (49 pages)
UPDATE June 29, 2017: The CBO issued a four page update to their review of the revised version of the Senate healthcare draft. That publication can be found here:
“Longer-Term Effects of the Better Care Reconciliation Act of 2017 on Medicaid Spending,” by the Congressional Budget Office (CBO); June 29, 2017 (4 pages)
A summary article is here: “Longer-Term Effects of the Better Care Reconciliation Act of 2017 on Medicaid Spending,” by the Congressional Budget Office (CBO); June 29, 2017
The Senate Republicans want to vote on Trumpcare by July 4, 2017. Here is the number for the switchboard to call your Senators:
Tell your Senators to vote No on Trumpcare. When you call, please refer to it as “The Better Care Reconciliation Act of 2017” (or BCRA). Although it is currently referred to as H.R. 1628, this may change as the bill reaches the Senate floor for a vote.
“Call your senator: Phone numbers for every office of every U.S. senator,” by David Nir, Daily Kos; February 2, 2017
 “22 Million More Uninsured under Senate GOP Health Care Bill, CBO Reports,” by Jeffrey Young, Jonathan Cohn, HuffPost; June 26, 2017
Excerpt: Twenty-two million fewer people would have health coverage over the next 10 years under legislation that Senate Republicans aim to bring to the floor for a vote this week, according to the Congressional Budget Office.
The measure would dramatically scale back federal funding for Medicaid and financial assistance low- and middle-income people receive to make private health insurance affordable. The hundreds of billions of dollars saved would mostly be transferred to wealthy people and health care companies in the form of tax cuts. And the bill would reduce the federal budget deficit by $321 billion over the coming decade.
“Republican Health Bill Would Leave 22 Million More People without Insurance, CBO Projects,” by Patrick Caldwell, Mother Jones; June 26, 2017
Excerpt: The Senate’s bill could wreak havoc on the Obamacare marketplaces for people who need to individually buy insurance. Currently, insurance companies can’t charge their oldest enrollees more than three times as much as the youngest. The GOP bill changes that ratio to 5:1, jacking up premiums for older Americans. Obamacare currently offers subsidies to help offset monthly premiums for people earning up to 400 percent of the poverty level; the GOP bill would lower that threshold to 350 percent.
Under Obamacare, moreover, those subsidies are currently intended to help people buy so-called silver plans, which cover 70 percent of patients’ out-of-pocket. The Republican bill would lower those subsidies to purchasing skimpier coverage, with insurance companies now covering just 58 percent of out-of-pocket costs under the new subsidy formula. The bottom line: Deductibles would skyrocket.
“Trumpcare is deathcare, as Republicans are ready to kill innocent Americans to give tax cuts to the top two percent.”
“CBO Confirms that Senate Healthcare Bill will be Deathcare for Poorer Americans Age 50-64,” by Jason Easley, Politics USA; June 26, 2017
Excerpt: Without health insurance, many of those Americans who have preexisting conditions and age 50-64 will die. Trumpcare is deathcare, as Republicans are ready to kill innocent Americans to give tax cuts to the top two percent.
“Here’s a dark fact: Every single GOP senator who calls him or herself pro-life who votes for the Republican health care bill knowingly will be voting for legislation that will kill tens of thousands of Americans per year.”
“‘Pro-Life’ Republicans are Pushing Bill that will Kill Thousands,” by David S. Cohen, Rolling Stone; June 26, 2017
“Senate Republicans Revise Health Bill to Penalize Uninsured,” by Thomas Kaplan & Robert Pear, New York Times; June 26, 2017
Excerpt: The Senate proposal for a waiting period could also have problems. For someone with cancer or a severe illness, a six-month waiting period could be a death sentence.
“Being denied critical and potentially lifesaving health care for six months is not a fair punishment for someone who is a few hundred dollars short on insurance payments because they lost their job and finances are unexpectedly tight,” said Senator Chuck Schumer of New York, the Democratic leader…
In yet another rebuke from outside Congress, the A.M.A., the nation’s largest physicians organization, declared, “Medicine has long operated under the precept of primum non nocere, or ‘first, do no harm.’ The draft legislation violates that standard on many levels.”
“The trade-offs here are indefensible. The bill would take a trillion dollars away from health coverage for the bottom 50% of the population to give a tax cut to the top 2%.”
“How the Senate’s Health-Care Bill Threatens the Nation’s Health,” by Atul Gawande, The New Yorker; June 26, 2017
Excerpt: Conservatives often take a narrow view of the value of health insurance: they focus on catastrophic events such as emergencies and sudden, high-cost illnesses. But the path of life isn’t one of steady health punctuated by brief crises. Most of us accumulate costly, often chronic health issues as we age. These issues can often be delayed, managed, and controlled if we have good health care—and can’t be if we don’t.
Conservatives also dismiss Medicaid by arguing that it provides inadequate or unsatisfactory coverage. The opposite is true, according to the evidence. Compared with private coverage, Medicaid produces at least as much improvement in access to care, measures of health, and mortality reduction. And polls indicate that recipients like Medicaid more than private coverage, even with the difficulties finding doctors who take Medicaid, because the program provides them with better financial protection.
Despite these facts, the Senate reform bill, like the bill that House Republicans passed earlier this year, would hollow out or terminate coverage for tens of millions of Americans who rely on Medicaid or the private-insurance exchanges set up by the A.C.A. These bills are, in many ways, Medicaid-repeal bills masquerading as Obamacare-repeal bills. And Medicaid, remember, is not a program that the public is complaining about. It is immensely popular and works well. It provides coverage for sixty per cent of disabled children, and maternity coverage for half of pregnant women. Two-thirds of nursing-home residents end up relying on Medicaid coverage after their savings are spent. Among adult Medicaid recipients, sixty per cent work, and eighty per cent are part of working families.
“Senate GOP revises health bill in hunt for votes,” by Burgess Everett and Jennifer Haberkorn, POLITICO; June 26, 2017
Excerpt: The revised Senate bill would include a six-month ‘lock out’ period in which people who don’t have insurance have to wait before their policy takes effect. The lock out would apply to people who have been uninsured for at least 63 days; people would not have to pay their premiums during that time. The House bill would have allowed insurance companies to charge uninsured people up to 30 percent more for up to one year.
“What changed in Senate healthcare bill?” by Bob Bryan and Lydia Ramsey, Business Insider; June 26, 2017
Excerpt: The revised version of the bill includes a provision that’s meant to replace the Obamacare individual mandate by punishing people whose insurance has lapsed, by locking them out of coverage for six months.
The revision closes a loophole that the original bill had that could have hurt the health insurance market. To avoid adverse selection in the individual insurance market, there needs to be a continuous-coverage provision to keep healthy people buying insurance instead of waiting until they’re sick.
Healthier people help to pay into the pool and ensure that costs for everyone stay lower. To make sure that the market isn’t full of exclusively sick people – resulting in higher costs and financial losses for insurers – there needs to be some reason for healthy people to sign up. The most effective way to do so is not only the carrot of coverage benefits, but also a stick to punish those that do not have coverage.
Under Obamacare, this stick was the tax penalty for not having coverage. In the House Republican bill, people that did not maintain coverage the year before could have their premiums raised as much as 30% on top of normal costs as a penalty.
The bill also tweaks some of the language in section 106, which discusses stability funding for states.
Draft legislation violates the standard of “First, do no harm”
“Senate Republicans plan to revise health care bill,” by Tom Howell Jr., Washington Times; June 26, 2017
Excerpt: The American Medical Association blasted the plan Monday for cutting Medicaid spending, allowing insurers to offer skimpier coverage and replacing Obamacare’s subsidies with less generous tax credits, citing the doctor’s oath to “first, do no harm.”
“The draft legislation violates that standard on many levels,” AMA CEO James L. Madara said.
“American Medical Association blasts GOP health care bill: It violates ‘do no harm’ oath,” by Oliver Willis, Shareblue; June 26, 2017
“American Medical Association says Senate health care bill violates pledge to ‘do no harm’,” by Emily C. Singer, MIC; June 26, 2017
Updates will be forthcoming.