Local healthcare advocates breathed a sigh of relief after Senate Majority Leader Mitch McConnell pulled his version of Trumpcare from the Senate floor on Tuesday, but they worried that the Republican health plan will just be resurrected next month, in a deja vu of what happened with the House version.
McConnell pulled the bill after the nonpartisan Congressional Budget Office panned Trumpcare 3.0, as it had two earlier versions, projecting that 22 million more people would be uninsured in 2026 than under existing law. Almost a dozen Republicans balked at supporting McConnell’s bill, from both the center and the right.
Fifteen million people would go uninsured next year, as seniors would see a sharp rise in their premiums and younger people only purchasing care because of the tax penalty would forgo buying plans with increasingly high deductibles. Premiums would also rise 20 percent next year before potentially lowering in 2020.
“It shows the product of the secretive process was not a consensus item among the majority caucus,” said Jesse O’Brien, the policy director at the Oregon State Public Interest Research Group. “Additional time may only make it harder.”
O’Brien said Trumpcare 3.0 would hit older people especially hard -- insurers could charge them five times more than younger adults and they would be forced to pay a higher percentage of their income on premiums before the government would offer subsidies.
A lockout penalty would also discourage healthy people from signing up, leaving a riskier pool and creating increased chaos for the market.
O’Brien added that the CBO’s depiction of lower premiums in 2020 was a bit misleading from a consumer perspective.
For the federal budget, the average premium could be lower even if they are still much higher for today’s consumer. That’s because the makeup of the plans and the people who would be buying them would be quite different. If Trumpcare were to pass, it would shut older people out of the market and the average remaining plans would have a lower actuarial value than today’s.
The projected premium costs of plans under Trumpcare 3.0 are lower than they would be under current law because the average age of consumers still buying them would be younger, and they’d be purchasing plans with higher deductibles.
In 2020, cost-sharing reductions that help people pay out-of-pocket costs under Obamacare would disappear, pushing working-class people out of the market.
“If you’re a low-income person, these plans are almost totally worthless to you,” O’Brien said.
The cuts to Medicaid do not initially kick as many people off the program as the House bill, but that’s still where the bulk of the $321 billion savings come from. The Senate dropped the continuous coverage requirement and doesn’t start ratcheting down Medicaid payments till 2021 -- after the next presidential election.
In later years, it would limit cost growth rather than allowing costs to keep rising in some states without controls.
This would affect Oregon less than most states, since the state Medicaid program has already agreed to just such a cost control of 3.4 percent growth. Long-term care for seniors and people with disabilities, however, is not bound by such cost caps and would have to limit revenue increases to 4.5 percent, even as labor costs rise at a higher rate for these providers.
And by 2025, the Senate Republican plan switches its index from medical inflation to regular inflation, which is typically much lower.
Jon Bartholomew of AARP said his organization would not assume that it will be harder for Senate Republicans to pass a slightly altered Trumpcare bill than it was for the House of Representatives. And he said AARP would target key senators in swing states and states that expanded Medicaid, such as Sen. Dean Heller, R-Nev., whose opposition was critical to the canceled vote.
“On the House side, they delayed and cut some deals and came back and passed it,” Bartholomew said.
In addition to the other cuts mentioned, Bartholomew said the bill also cuts Medicare by repealing a payroll tax on wealthy Americans and leaves the program vulnerable to being reduced to a voucher system -- all while giving big tax cuts to health insurance and pharmaceutical companies.
In the Democratic response, Oregon Sen. Ron Wyden led the charge for his caucus on the Senate floor: “Political change in America doesn’t start in Washington, D.C., and trickle down. It starts from the bottom-up. … We need you to stay loud. That is the only way we stop this bill in its track.”
Democratic Gov. Kate Brown echoed his sentiments on Wednesday: “The legislation is cruel. It forces Americans to pay more for inferior care.”
Wyden warned that the Senate version of Trumpcare would cost the government about $200 billion less than the House version, giving McConnell plenty of wiggle room to persuade rebellious Republicans with sweetheart deals. One such possible measure would give Alaska and very rural states special treatment that would not apply to 45 states.
Some right-wing senators also would like to restore medical underwriting and allow health insurers to charge sick people more than healthy adults, while stopping short of denying them access to coverage if they’ve got the money.
Reach Chris Gray at [email protected].