Senate Health Care Repeal Bill Filled with Earmarks and Payoffs

Mitch McConnell can’t afford to lose Republican votes if he wants to push through the terrible Senate Republican “Better Care Act,” a massive tax cut for the rich masquerading as a health care plan. It’s Mitch McConnell’s Magic Health Elixir guaranteed to provide better care for less.

Several Republican senators know that the bill is bad for their state, so McConnell has tossed in some goodies to give them a better shot at spinning the bill and hiding its massive health care cuts from their constituents.

Here are some of the things on the McConnell goodie list—and don’t be fooled. These are just bones. None of these are any substitute for giving state residents real, dependable, affordable access to care. That’s what the Trump administration promised. That’s not what the Senate is delivering.

The Dunce Cap

The bill makes huge cuts to Medicaid by capping federal Medicaid funds at a low level. But Republican Senators have worked to exempt their own states from the worst of the cuts and to shift even more extreme Medicaid reductions on to states with Democratic Senators. The plan rewards lower performing states by offsetting the worst of the Medicaid cuts with added money for states that spend less on Medicaid enrollees. Only a dunce could think this is going to be close to enough money to offset the bill’s cuts.

It is no accident that these states have Republican Senators. They include states like Arizona, Colorado and Nevada—where Senators are going to have a tough time explaining a vote for a bill that will take health coverage away from hundreds of thousands of state residents now covered through the expansion regardless of their partisan Medicaid funding games.

Klondike-Cowboy Kick-Back

On the other end, the bill penalizes states with higher Medicaid spending—but exempts those Frontier states with low-population density states from that penalty. Five states meet the exemption: North Dakota, Montana, South Dakota, Wyoming and The Last Frontier State-Alaska. Those are states with must-get Republican votes for Mitch. The bill lets those states spend more and not risk getting dinged, like other high spending states. The exemption’s no tradeoff for losing the Medicaid expansion—that’s something that will take health coverage away from over 14,000 Alaskans; 20,000 North Dakotans; and, 47,000 Montanans.

The Drop-In-The-Bucket Grants

Senators from states like Ohio and West Virginia that have been hit hard by the opioid crisis are rightfully concerned about a bill that will strip health coverage from thousands of their state residents. So the bill includes a small pot of money for state grants to treat opioid addiction. Let’s be clear: treatment grants are no substitute for comprehensive, affordable health coverage.

The Bait and Switch (BS) Coverage

The bill lets people below poverty get subsidies to buy the bill’s gutted marketplace coverage. Senators from states that expanded Medicaid can pretend that this replaces the Medicaid coverage millions will lose. Senators from states that didn’t expand Medicaid can pretend this is a real option for the uninsured. Might sound good, but what’s being offered is unaffordable. Under the Senate bill, most marketplace enrollees will see deductibles of over $7,000—that plus premiums at 2% of income is not real insurance coverage for someone making less than $12,000 a year, the poverty level. It’s trading real insurance for BS coverage.

The Shell Game

The ACA funded coverage through Medicaid expansion, but since the Better Care Act is doing away with the expansion, hospitals will be stuck with the bill for uncompensated care. So Magic Mitch moves the money around from coverage to hospitals. The bill includes a tiny bit of money for hospitals in states that didn’t expand Medicaid. That lets Senators in those states claim a victory for their state’s health system, but that’s not the same as health insurance for real people—an option this bill takes away from those states. And it isn’t a long term solutions to hospitals that will see growing uncompensated care costs—and with this bill, that’s going to happen in every state.

The bill is filled with grants and bonuses and other payments—these are just a few. These are bones that Senators would be taking back to their constituents if this bill passes, and no replacement for the real health care improvements most of their constituents wanted—and thought they were voting for in November. Tell your senators not to fall for this con game.