All The Really Vomity Parts Of The Senate's Obamacare-Killing 'Better Care' Act

You'll be so sick of winning. Or just of being sick.

So the Senate's version of Obamacare repeal has finally dropped with a mighty splash, and dear Crom, it is a big ol' stinky one. As Ezra Klein says at Vox, it "takes what Americans hate about Obamacare and makes it worse." It keeps some aspects of the Affordable Care Act -- at least in name only -- but makes health insurance more expensive and far crappier, rolls back the ACA's Medicaid expansion, and cuts Medicaid as a whole even more than the terrible House version did. This thing is a disaster that will let people die of preventable illnesses and drive families into bankruptcy, which means it will probably become law. At least it has a memorable name: the "Better Care Reconciliation Act."

If you look really closely with a scanning electron microscope, there's an asterisk that clarifies: "Not better than the ACA, but probably better than health insurance in Somalia."

Sarah Kliff at Vox has a detailed explainer, which you should read, and Pensnylvania Democratic Senator Bob Casey highlights some of the worst of the worst in this Twitter thread. Let's put on our HAZMAT suits, dab some Vicks under our nostrils, and take a look at this mess, which will sacrifice the budgets and health of the middle and working class, not to mention more than a few lives, so the very wealthy can have a huge, no really, HUGE, tax cut.

As we've already discussed, this beast is going to be terrible for the poor, rolling back the ACA's Medicaid expansion for 14 million people just like the House version does, but with one very important difference: That rollback will start in 2020, so that maybe Republicans can get through another election or two before the worst pain really hits people. Isn't that thoughtful of them? Since the Medicaid cuts are the one thing we already knew would be horrific, and we've gone over them in some detail, we're going to move on to other stuff here. Not because the Medicaid cuts are unimportant -- they're central to this fucked-up plan's cruelty and to freeing up revenue for the tax cuts. The program will be gutted over the next 10 years, and people will die. 

For people buying insurance on the individual marketplace, "Better Care" will reduce the amount of tax-credit support for all users, and subsidies will be cut off once buyers' incomes reach 350 percent of the poverty level ($41,580 for individuals; $85,050 for a family of four) instead of the ACA's 400% ($47,550 / individual; $97,200 / family of four). Not only will it allow states to opt out of participating in the individual marketplaces, it will actually do even more to move individual insurance toward mostly consisting of hollow "junk insurance" plans. Where the House bill allowed states to allow the sale of plans without the ACA's essential health benefits -- stuff like ER coverage, maternity and gynecological care, hospitalization, prescription coverage, coverage for major illnesses, and mental health coverage -- Slightly Better Than Nothing Care just plain eliminates the requirement for essential benefits for people on Medicaid starting in 2020. It's right there on Page 41:

For people on individual health plans, states would have an easier time opting out of EHB mandates -- instead of those waivers being requested by state legislatures, a state's governor could unilaterally request the waiver. Presto! In many states, no more arguments about mandating birth control benefits for companies' whore lady workers -- there simply won't be any requirement that insurance provide it for anyone. You can buy insurance with that if you want. For a lot more. The standard for insurance will now be much less useful plans that make you pay much more for care.

Where the House bill replaced the ACA's individual mandate with a provision allowing insurers to jack up rates for people who go two months without insurance, the Senate version eliminates both the individual and business mandates altogether, and replaces them with nothing at all. So there goes any incentive for younger, healthier people to buy insurance, which was a key part of making the ACA's protections for people with preexisting conditions affordable. As Kliff notes (heh) at Vox:

The Senate bill still requires insurance companies to accept all patients, regardless of how sick they might be or what preexisting conditions they have. Building a health insurance system without an individual mandate or any replacement policy runs a significant risk of falling into a death spiral, where only the sickest people buy coverage and premiums keep ticking upward.

That's a hell of a plan: It has a death spiral designed in, so future Republicans won't have to induce a death spiral by refusing to pay for individual market subsidies.

 Like the House plan, the Senate bill allows insurers on the individual markets to charge older enrollees premiums up to five times more than younger adults. The Senate pushes the implementationof that "age tax" from 2018 to 2019, again, presumably because then maybe we olds will have forgotten who did it to us. (Not. Bloody. Likely) 

Oh, and remember how some Republican "moderates" like Rob Portman were fretting that there wasn't enough help for people trying to kick opioid addiction? Better Die Quickly Care includes $2 billion in aid for opiate addiction. For one year -- the House bill covered 10 years.

So here's a heck of a surprise: People DO NOT LIKE THIS PLAN. Disability rights protesters blocked the halls outside Mitch McConnell's office after the bill was released, chanting “No cuts to Medicaid — save our liberty!” as if having access to medical care and adaptive equipment had something to do with "freedom."

Huge protest inside and outside of Senate Majority Leader Mitch Mcconnell's office happening right now. pic.twitter.com/Iu9wet6cXx 

— Mariam Khan (@MKhan47) June 22, 2017