Well, the Senate has finally decided to whip it out. The Better Care Reconciliation Act (BCRA) — the Senate version of the House’s AHCA — has been pulled out from under Mitch McConnell’s trench coat, still moist and sweaty from his tumescent excitement to slap the BCRA in front of the Senate before the July 4th recess.
And before the American public has time to realize what’s being done to them.
The last thing the GOP wants is for their constituents to get in the way by insisting their senators listen to their wishes. Ol’ Mitch, the Modern Machiavelli, has a plan. But is it repeal and replace Obamacare? Or only appear to give it the old college try?
He has ridden the issue as far as it could take it, with the Republican Party now holding all the reins of Washington power. Now all he has to do is appease the slavering base and tantrum-prone president.
Here, have a piece of candy. Look, what is that over there?
McConnell knows that no new entitlement has ever been rescinded. And now that 20 million have gained healthcare thanks to the Affordable Care Act — which is more popular than ever — they’re starting to realize that imperfect healthcare is better than no healthcare at all.
He knows that the BCRA could very well imperil his beloved, yet slim Senate majority. Is it a coincidence that the two senators up for reelection in 2018 are among the BCRA skeptics? Both Jeff Flake of Arizona and the critically endangered Dean Heller of Nevada also hail from Medicaid expansion states. (Coincidentally, Heller just announced his opposition to the bill.)
The other “moderates” who have expressed severe reservations — with the exception of Susan Collins of Maine — also come from expansion states. As a sop to these holdouts, the Senate Trumpcare bill slows and softens the Medicaid expansion rollback.
And, in a bit of too-clever-by-half pandering to the right, it does this by robbing Peter to kick Tiny Tim into the gutter. People like me who qualified for Medicaid before Obamacare — in my case Medicaid disability — will find services gutted and rolls purged because the Senate plan is actually far stingier than the House bill President Trump branded “mean.”
Instead of tying future Medicaid funding to the medical component of the Consumer Price Index, which grows more slowly than the actual projected Medicaid costs, the Senate scheme would tie it with the general Consumer Price Index. It grows much, much more slowly.
Said Sara Rosenbaum, George Washington University professor of health law and policy:
The Senate bill creates an illusion of being less draconian than the House bill, but is arguably more so.
The Kaiser Family Foundation’s Drew Altman further expounded:
Both the Senate and the House plans also impose a per capita cap on future federal Medicaid spending. The Senate plan imposes a harsher formula for its cap than the House plan, which already cuts Medicaid spending by $834 billion over 10 years. Because states have to balance their budgets every year, unlike the federal government, many will struggle to compensate for reductions in federal aid caused by a spending cap. Many states will be forced to choose between Medicaid and other priorities, like education, law enforcement and prisons. The inevitable result will be a reduction in health care spending on low-income people. And you cannot cut over $800 billion from Medicaid without adversely affecting health services for the poor.
And, as a NY Times Upshot analysis summed up:
Most researchers who study the program closely say that it is already quite lean. Major savings, they say, will be hard to achieve without reducing medical benefits or cutting higher-cost patients from the program.
BCRA: Tripping Up Medicaid Recipients
I spent much of Thursday — the very day Mitch finally revealed the blueprint for the BCRA — seeking treatment for a broken foot. ( Not again! I can hear the cry echo.)
Though the proximate cause of my accident was my lifelong ADHD distractibility, the damage was almost certainly exacerbated by my prednisone-caused severe osteoporosis. In the past, I may well have tripped but not fractured the bone clean through.
I am, as you’ve no doubt gathered, a medical care frequent flyer. But for people like me, the BCRA’s bonus points will in the future kick them off of Medicaid.
Even in liberal California,Medi-Cal — our version of Medicaid — cut back many services during the Great Recession. There will be other economic contractions. When that happens, or if there’s an epidemic or new, expensive treatment comes along, state Medicaid programs will be forced to make cutbacks.
The easiest way is to cut the most expensive patients. Bye bye, nursing home care. Medicaid pays for 65% of nursing home patients (the figure rises to 75% for long-term care). And so long to the 30% of disabled adults covered by Medicaid (the figure rises to 60% for disabled children).
I would probably be among the most vulnerable among the disabled Medicaid recipients, since I my Medicaid application was initially turned down. Though I’m now far more disabled (this was before my autoimmune disease, coma, strokes, osteoporosis, etc. etc.), I won my appeal due to my multiple severe, chronic and debilitating conditions then.
My sheer quantity of conditions might seem to put me on the fast track to coverage, but if Medi-Cal is put on a starvation diet, the program might well begin to comb through the rolls to find recipients to ax.
In a Medicaid coverage Special Olympics, I would certainly lose to a paraplegic. That sort of culling would certainly happen in states that are far more conservative than the deep-blue Golden State.
The Center for American Progress estimates — based on the CBO’s estimate of the House’s AHCA and on Massachusetts’ mortality rates under Romneycare — that 18,100 to 27,700 more people will die by 2026 due to the BCRA. And this vast toll of human suffering is all feed the rich a massive tax cut.
Which only goes to show that the GOP is lactose intolerant of the milk of human kindness.
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