Anyone who knows anything about healthcare didn't need a Congressional Budget Office scorecard to understand the disastrous consequences of the American Health Care Act.
That legislation, now before the Senate, passed the House in early May in a straight party-line vote without hearings or a CBO score. Now we know the score: 23 million would lose their health insurance over the next decade, including 14 million by the end of next year.
That's 1 million more than the estimated 22 million people who obtained coverage through the Affordable Care Act. So that's what the "replace" in "repeal and replace" meant: replacing the ACA with less than nothing.
The bill doesn't stop with reseeding the ranks of the uninsured. For those with coverage, things would get considerably worse. About 1 in 6 Americans would be cut off from the ACA's guaranteed coverage for people with pre-existing medical conditions.
The CBO said the limited funding in the bill for states seeking waivers to create high-risk pools would be inadequate. "People who are less healthy (including those with pre-existing or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all," the CBO said.
The healthy would hardly fare better. The plans provided to the uninsured through the individual market would be far less comprehensive than existing plans because the subsidies would be sharply reduced. The total premium would be less only because "the insurance, on average, would pay for a smaller proportion of health care costs."
In other words, under the Republican plan, total premiums would go down, but the out-of-pocket share of those premiums would go up. And the co-pays and deductibles paid by those who need to use their insurance would skyrocket.
Not content with undermining the ACA's achievements, the AHCA would also wreak havoc on state Medicaid programs. It replaces the existing program with per capita block grants, whose growth would be pegged to inflation—not the increase in actual medical costs. This would shrink the projected growth in the program under existing law by $864 billion over the next decade.
And to what end? To reduce taxes for the well-to-do and some corporations and to shrink the deficit by $119 billion over the next decade. Let's put that in perspective. It's just 0.4% of the total federal deficit, which is projected to grow by 68% over the period.
And who would pay the price for those tax breaks and the minuscule deficit reduction? Arbitrarily limiting the growth rate in Medicaid would force states to make draconian cuts in how they serve the 74 million people now in the program.
Let's enumerate once again who would be asked to make these sacrifices. The disabled currently are 15% of the Medicaid population and use 42% of program resources; the destitute elderly in nursing homes are 9% of beneficiaries, and use 21% of resources; and children are 48% of beneficiaries, and consume 21% of Medicaid dollars.
Working age adults who are on Medicaid because they are unemployed or earn poverty wages—the new "welfare queens" in today's Republican mythology—constitute 27% of enrollees but consume less than 1 in 7 Medicaid dollars. Imposing personal responsibility requirements on this group may salve some angry souls in the body politic, but it would do nothing to help people whose only sin is to be old, infirm or young while poor.
The AHCA, when seen in the light of President Donald Trump's proposed budget cuts to the National Institutes of Health, the Centers for Disease Control and Prevention, and food, housing and other social services, constitutes the most radical attack on public health in the nation's history. Its extremist architects in the House and in the White House should be ashamed.
The fight now turns to the Senate, where, hopefully, wiser, more moderate heads will prevail.
