(Bloomberg) — Avik Roy says the Republican Obamacare overhaul bill would make health insurance unaffordable for the poor. Robert Laszewski calls it a "mind-boggling" approach that could collapse the individual market. Seth Chandler warns it could put care out of reach for older Americans.
And that's just wonks on the right.
The effects of the long-promised measure to change major Medicaid and commercial health insurance components of the Affordable Care Act would fall mainly on the poor, a fact that has set off opposition from both left and the right. The bill would cut taxes to the tune of about $575 billion over a decade, mainly on the wealthy and health insurance companies.
It would limit money channeled to low-income people, raise costs for older Americans and wind down the expansion of Medicaid.
"There's no question the goal is to substantially reduce the federal commitment to providing subsidized care for the low-income population," said Len Nichols, a health policy professor at George Mason University. "The very population that voted for Trump, the working class out there who are in the positions of not having good employer-sponsored coverage anymore or ever, they're going to end up worse off."
ACA programs pulled about 20 million people into commercial and public health insurance programs, bringing the U.S. uninsured rate to a record low. The law provided subsidies to help low-and middle-income people afford health insurance, and also pushed states to expand their Medicaid programs to more low-income people.
The bill will be debated Wednesday in two House of Representatives committees, before making its way to the floor. Republicans then would have to navigate the Senate, where they hold a 52-48 majority.
Most proposed changes in the bill, backed by House Speaker Paul Ryan, wouldn't go into effect until the start of 2020. About 2 million to 4 million people would lose coverage in the individual market starting that year, while another 4 million to 6 million would lose their Medicaid coverage, S&P Global Ratings estimated Tuesday. There could be higher premiums or weaker coverage for many, particularly the elderly and those with lower incomes. At the same time, there would be less incentive for healthy people to buy insurance.
"It appears the real objective is a tax cut for the wealthiest Americans, and they're trying to do this on the backs of the most vulnerable," said Jim Carnes, policy director at Alabama Arise, advocates for low-income people in the state.
The drafters of the bill wrote provisions directly aimed at certain forms of income.
Executive pay raise
On one hand, the measure makes it easier for health insurers to pay executives more. The proposal would lift the guaranteed deduction on compensation to $1 million from $500,000 and also lets insurers deduct any pay linked to performance.
On the other, it would ensure that winners of lotteries, disproportionately played by the poor, wouldn't get a free ride based on a change in Medicaid formulas to cut them off.
"This is a classic example of Robin Hood in reverse," said Ron Pollack, founding executive director of Families USA, an advocate for affordable health care. "It hurts the low income, children, seniors and people with disabilities who depend on the safety-net Medicaid program for their lifeline. It also hurts those people who need additional subsidies in order to afford their premium costs."
Cancer patients could also lose access to care or would be "left to buy coverage that doesn't meet their needs," Chris Hansen, president of the American Cancer Society's Cancer Action Network, said in a statement.
