Health Care

The Senate TrumpCare Bill Fails All Americans


It Fails People with Pre-Existing Conditions

The Senate’s version of the TrumpCare bill is out, and it’s as monstrous as we thought it would be. In order to give billions of dollars in tax breaks to the wealthy and corporations, it makes the deepest cuts to Medicaid in its 52-year history. Not only does it end the Medicaid expansion, it fundamentally (and permanently) alters Medicaid in a way that threatens the well-being of low-income families across the country.

Another terrible part of the bill is that it ends guaranteed protections critical for people with pre-existing conditions. You may have heard just the opposite—that people with pre-existing conditions are protected, and that this version of TrumpCare is “nicer” or “better” than the House version for that reason. Don’t fall for it. It’s still much worse than current law. And, if you’re one of the 130 million Americans with a pre-existing condition, you could be the one paying the price.

How the Affordable Care Act protected people with pre-existing conditions

The ACA has a provision requiring insurance companies to set premiums rates by “community rating,” which, when translated from wonk to English, means that people with pre-existing conditions can’t be charged more for insurance than those without. It worked.

This provision works hand-in-hand with another ACA protection for consumers, the requirement that all health plans cover “essential health benefits.” This is the menu of different coverage benefits insurers are required to cover, and it includes maternity care, mental health, and prescriptions. If plans aren’t required to cover needed benefits, especially care that people with pre-existing conditions need, it doesn’t matter whether you’re protected from being charged more for plans, because insurance companies can design plans to explicitly deter people with pre-existing conditions from enrolling. “Community rating” doesn’t work unless backed up with “essential health benefits.”

How the Senate version of TrumpCare changes this

The Senate bill allows states to opt-out of covering essential health benefits, which means insurance companies can stop offering plans that cover the kind of services people with pre-existing conditions need. This has the effect of driving up the price for consumers for plans that offer the broader coverage they need, likely to the point where no one could afford it.

In other words, the Senate TrumpCare bill gives insurers a backdoor way of discriminating against people with pre-existing conditions.

How Ted Cruz wants to make this worse

Senator McConnell has a tight needle to thread: he’s trying desperately to recruit “moderate” Republicans that are holding out, but he also needs to keep the extreme wing on board. That’s why he’s pushing a proposal from Ted Cruz that will allow insurance companies to sell plans that have fewer benefits and patient protections as plans currently sold through the marketplace. They’re allowed to do this as long as they sell just one plan that complies with the ACA requirement to cover essential health benefits that people with pre-existing conditions rely on.

What will this mean? People with pre-existing conditions will have no choice but to pay higher costs in order to get the plans that cover the treatment they need. This could also create serious confusion for customers buying through the exchange when trying to understand which plans cover their necessary treatments and which do not.

Don’t believe them when they say people with pre-existing conditions are protected

Here’s the bottom line: under current law, people with pre-existing conditions have guaranteed access to health insurance that covers the care they need. They cannot be discriminated against for having a pre-existing conditions. Under the Senate TrumpCare bill, those protections go away. If affordable plans don’t cover the services someone with pre-existing conditions needs, it doesn’t matter whether they have access to it or not.

It would Raise Health Care Costs for all American

The Senate’s version of the TrumpCare bill is out, and it’s as monstrous as we thought it would be. In order to give billions of dollars in tax breaks to the wealthy and corporations, TrumpCare continues to make the deepest cuts to Medicaid in its 52-year history. Not only does it end the Medicaid expansion, it fundamentally (and permanently) restructures Medicaid in a way that threatens the well-being of low-income families across the country. TrumpCare fails people with pre-existing conditions.

But it also would drive costs for consumers way up. Even if your Senator claims to be a “no” on this bill right now, don’t fall for the charade. It’s all a trick. It’s so that they can later claim that they’ve worked to “fix” the bill, when in reality this bill is beyond repair. Here’s what consumers can expect under the Senate version of TrumpCare, and why you should tell your Senator to vocally and unwaveringly oppose it.

Premiums will go up

Like the House version of TrumpCare, you can definitely expect premiums to go up if the Senate version becomes law. That’s in part because it allows insurance companies to charge seniors more than they can under current law. TrumpCare also gets rid of what’s called the “individual mandate,” the requirement that people have health insurance or face a penalty. This key feature of the Affordable Care Act is what kept premiums from rising more steeply.

Consumer costs will increase while subsidies go down

The percentage of consumer costs covered by plans will decrease. Currently, plans have to cover at least 70% of the health care costs incurred by a consumer. TrumpCare drops that number to 58%, meaning consumers could see their out of pocket costs go up for things like co-pays and prescriptions. It will be much more expensive for you if you get sick or injured.

At the same time, TrumpCare reduces help to consumers buying insurance. Current law provides many Americans tax credits that offset the cost of their monthly premiums. The tax credits are available to anyone who makes less than 400% of the Federal Poverty Level. (In 2016, that is about $48,000 for a single person.) The Senate version of TrumpCare lowers that threshold to 350%—meaning higher premiums for middle-class families. But it gets worse: the tax credits under TrumpCare would be pegged to a lower-quality plan in your area. So not only will tax credit be less, they won’t go as far. And that affects anyone who receives them.

Higher costs for worse benefits and services

TrumpCare provides a loophole for insurance plans participating in the exchanges that allows states to get waivers of what are called “essential health benefits” (EHBs). EHBs define the menu of health care services that insurers must cover, including maternity care, mental health care, and prescriptions. If insurance plans aren’t required to cover certain services, then the health insurance is meaningless. By allowing waivers of EHBs, TrumpCare sends people back to the days of skimpy health plans and deciding whether to buy prescription drugs this month or eat. And, if consumers want better services, they’ll have to pay for them out of pocket, at a drastically higher price.

Consumer rebates end along with key insurance restrictions

Another feature of the the ACA is a requirement that insurance companies use money paid by consumers on actual health care services, and not wasted on other things. More specifically, plans must spend at least 80% of the premiums collected on providing actual health care, and not on administrative costs, marketing campaigns, CEO salaries, or—most importantly—profits. This ACA requirement returned a staggering $396 million to 4.8 million families in 2015. On average, families that paid premiums got a rebate of $138 back, taken out of shareholder profits. But TrumpCare would get rid of this starting next year. After that, it’s up to individual states to decide whether they’ll keep protecting consumers from insurance plans’ wasteful spending.

It Destroys Medicaid as We Know It

The Senate’s version of the TrumpCare bill is out, and it’s as monstrous as we thought it would be. It fails people with pre-existing conditions and would drive up costs for Americans.

But perhaps the worst part is what it would do to Medicaid. In order to give billions of dollars in tax breaks to the wealthy and corporations, TrumpCare makes the deepest cuts to Medicaid in its 52-year history. Not only does it end the Medicaid expansion, it fundamentally (and permanently) restructures Medicaid in a way that threatens the well-being of low- and middle-income families across the country.

Even if your Senator claims to be a “no” on this bill right now, don’t fall for the charade. It’s all a trick. It’s so that they can later claim that they’ve worked to “fix” the bill, when in reality this bill is beyond repair. This is especially true for Senators who will tell you they worked to get a longer “glidepath” or “phaseout” for Medicaid. They have no plans for how to transition their state out of Medicaid—whether it’s in 3, 5, or 7 years. Here’s how this bill destroys Medicaid as we know it, and why you should demand that your Senator vocally and unwaveringly oppose it.

It ends the Medicaid expansion

One of the key ways the Affordable Care Act so successfully increased the number of people with health care coverage was by expanding the groups of Americans that are eligible for Medicaid. 11 million Americans got coverage through the expansion of Medicaid. And, importantly, this expansion is paid almost entirely by the federal government—at 100 percent initially and then at 90 percent after 2020. This means that states can insure more of their residents without incurring many additional costs. It’s a win for states and a win for hardworking American families. If passed, TrumpCare would end that expansion, wiping out those important gains and putting American families at risk.

A Medicaid “phase-out” still rips health care from millions of Americans

“Moderate” Republicans who have negotiated parts of the bill in recent weeks claim to have lessened the blow by “phasing out” the expansion starting in 2021. But whether the expansion ends now or ends later, what it means in real terms is that millions of Americans will lose their coverage. It means that individuals who are now eligible for Medicaid will be unable to enroll, and many will be left without any coverage options at all.

It fundamentally transforms traditional Medicaid

Not only does the Senate version of TrumpCare end Medicaid expansion—it also makes deep cuts into traditional Medicaid. We can’t overstate what a fundamental remaking of Medicaid this is. Currently, Medicaid is an open-ended commitment. If you’re covered by Medicaid and you receive medical care, the federal government helps the state pay your insurance company for the services you received. And just as importantly, if you happen to be eligible for Medicaid, you get it. Period.

That is not the vision contemplated by TrumpCare: for the first time, Medicaid funding would be capped under a system called “per capita caps.” This means that access to Medicaid, even if you’re eligible, won’t be guaranteed. In practice, the caps in the Senate TrumpCare bill mean Medicaid funding will be cut deeper and deeper each year, covering fewer people, fewer services, or both. That’s because, as CBO confirmed, Republicans hid their deepest Medicaid cuts in the second decade. That’s when the growth rate for Medicaid starts growing at a slower rate than medical costs. What does all this mean In real terms? Millions of Americans would have to go without the care they need. Some might find themselves on waiting lists, and others on plans that are inferior to what they get now.

It hurts the elderly, children, and people with disabilities the most

A common misconception is that Medicaid is program that only serves low-income Americans. The truth is that Medicaid helps more people than commonly thought. Sixty-four percent of all nursing home residents use Medicaid. Seventy-six percent of all low-income children receive some kind of help from Medicaid. Children with disabilities receive Medicaid-funded help in school, even for services like speech-pathology, which this bill would end. In all, 20 percent of all Americans get some kind of help from Medicaid. This bill threatens all of them.

It Decimates Funding for Opioid Treatment

The Senate’s version of the TrumpCare bill is out, and it’s as monstrous as we thought it would be. It fails people with pre-existing conditions, it drives up costs for Americans, and it destroys Medicaid as we know it.

Leader McConnell had to postpone a vote on TrumpCare until after the July 4 recess because too many of his own members had concerns with the bill. So what’s he doing about it? He’s trying to buy off as many members as he can by making minor changes to the bill, whether it’s extending the Medicaid phase out, changing the Medicaid growth rate, or exempting certain populations from the new Medicaid caps.

Don’t be fooled. This bill is entirely unfixable—and these minor changes fail to make any real improvement to this bill.

One of McConnell’s biggest bribes for votes is putting more funding in the bill to fight opioid addiction. But there’s no way your Senator should fall for this token acknowledgement of what a serious crisis the opioid epidemic is. In 2015, more than 33,000 Americans died from an opioid overdose, and more than two million had an opioid use disorder. No matter how much additional funding is added—currently rumored to be $45 billion—TrumpCare still ends the Medicaid expansion and lets states waive essential health benefits. And though it may sound like a lot of money, $45 billion pales in comparison to the amount of guaranteed funding available to fight opioid addiction under current law, which this bill seeks to undo.

TrumpCare Ends the Medicaid Expansion

One of the main ways people who need addiction treatment get the care they need is through Medicaid, and the Medicaid expansion is associated with a significant drop in unmet need for addiction treatment. Many states cover inpatient detoxification, partial hospitalization, intensive outpatient services, and case management and care coordination through Medicaid.

11 million Americans got coverage through the expansion of Medicaid. And, importantly, this expansion is paid almost entirely by the federal government—at 100 percent initially and then at 90 percent after 2020. This means that states can insure more of their residents without incurring many additional costs. It’s a win for states and a win for hardworking American families. But TrumpCare ends the Medicaid expansion, and cuts even deeper into traditional Medicaid—shutting out many people living with an opioid use disorder.

Stated simply, the single most important thing Congress can do to address the opioid crisis is to preserve Medicaid, which is by far the most effective tool we have in the fight against addiction. Everything else is window-dressing.

TrumpCare Lets States Get Rid of Essential Health Benefits

“Essential health benefits” are the menu of different coverage benefits insurers are required to cover, and it includes mental health and addiction treatment. This requirement of the Affordable Care Act had a huge impact: prior to the ACA, one in three insurance plans did not cover addiction treatment. Every plan is required to cover it under current law.

TrumpCare allows states to let insurance companies get out of this requirement. Not only does this create a backdoor way to discriminate against people with pre-existing conditions, it also undermines treatment for opioid addiction.

Medicaid Coverage is Currently Guaranteed—TrumpCare Leaves it Up in the Air

Under current law, if you happen to be eligible for Medicaid, you get it. Period. And if you’re covered by Medicaid and you receive medical care, whether it’s for substance abuse addiction or something else, the federal government helps the state pay your insurance company for the services you received.

That is not the vision contemplated by TrumpCare: for the first time, Medicaid funding would be capped under a system called “per capita caps.” This means that access to Medicaid, even if you’re eligible, won’t be guaranteed. In practice, the caps in the Senate TrumpCare bill mean Medicaid funding will be cut deeper and deeper each year, covering fewer people, fewer services, or both. Many states will have no choice but to take Medicaid coverage away from people who are eligible.

What does this mean for people who need addiction treatment? It means they’ll have no certainty about whether their care will be covered or not. To add even more uncertainty, any extra funding for opioid treatment added to entice on-the-fence Senators to support the bill would not be locked in. It would only “authorize” future spending—not guarantee it. That means Congress could decide down the road to defund it, because opioid treatment would be competing with other discretionary spending priorities, like education, transportation, medical research, and protecting the environment.

$45 Billion is Not Nearly Enough

Though it sounds like a lot, $45 billion is totally inadequate to cover what experts think is actually needed. One Harvard expert believes as much as $183 billion is needed to battle the opioid epidemic—almost four times as much as what McConnell is reportedly offering to Senators. Also, the currently rumored pot of $45 billion for opioid treatment is stretched out over 10 years. It isn’t clear whether the bulk of that money is front-loaded—meaning funding dwindles out in future years—or if it’s averaged out over 10 years at $4.5 billion each year. But either way, people require treatment for addiction based on their own unique medical needs—not on Congress’s 10-year budget window.