Remember, the last one failed because it presented House Republicans with an impossible choice: vote no and disappoint their party, or vote yes and ensure the death and poor health of thousands of people in their district. (This isn’t an exaggeration; I’ll give some numbers below.)
Last night, lawmakers plastered on a few lipstick-like changes to the bill: things that they hope will make it look prettier and deflect some criticism, but that do nothing to change the fact that this is a terrible bill and they all know it. This interview with Pennsylvania Republican Mike Kelly gives a little insight: he admits that it breaks his promises to constituents, but he’s voting for it in the name of Republican teamwork. The Senate will magically fix all its problems, he suggests.
Anyway. Here are the most important parts of the bill that its proponents are hoping you don’t notice:
- You don’t need to be on “Obamacare” to see your insurance become useless. Since states can waive the essential benefits requirements, insurers in those states can offer junk insurance plans that look nice at first—hey, cheap premiums!—but if you get hit by a bus you could have to pay for your own surgery, hospitalization, or whatever they don’t cover. Even if you have insurance through your job, your employer could end up choosing one of these plans to save money. Reminder: even healthy, lucky, privileged young men (the group most in favor of cheap shitty insurance) can be hit by buses.
- Without essential benefits, there’s no limit on how much you pay out of pocket. Even if you have an okayish insurance policy, if hospitalization isn’t considered essential, then the law doesn’t put a cap on how much you can be forced to pay for it.
- Premiums could go up $4000 for people with asthma, $140,000 for people with metastatic cancer. That’s premiums, per year, for people buying their own insurance who had a gap in coverage. That’s going to be a lot of people, due to the other provisions of this bill. The House is holding this vote without a CBO score, so there is no official number on how much premiums will go up. In its place, though, we have these estimates from the partisan Center for American Progress, based on government data, that represent how much more these plans will cost insurers. And since healthy people won’t have to buy insurance, insurers have every incentive to keep their cheap plans cheap and their expensive plans expensive.
- The safety net for uninsured people is not going to be able to do its job. Lawmakers are talking about “high risk pools” where the government pays for care for people who can’t afford insurance. But high risk pools are really, really expensive and the law doesn’t allocate nearly enough money. The bill is $19 billion short. High risk pools were a thing in the past, and they didn’t work well then either.
- The real purpose of the bill is to “save” $880 billion to be used in tax cuts. The last-minute additions of $15 billion to help lower premiums and $8 billion for pre-existing conditions don’t change the big picture. The bill gets that $880 billion mainly from gutting Medicaid, the program that provides insurance for people who are poor, disabled, or need long term care. Nearly half of all births in this country are paid for by Medicaid. The saved money goes partly to repeal a 3.8 percent tax and a 0.9 percent tax currently paid by the wealthy; the rest enables a future “tax reform” bill to deliver even bigger cuts that will likely also benefit the rich far more than the poor.
- Yes, people will die. This one tends to get laughed off; can people really die from poor access to healthcare in our wonderful country? Here’s one small data point to prove it. When Obamacare allowed states to expand Medicaid to cover more people, the states that expanded coverage saved thousands of lives. There were 2,840 more deaths per year per state in those that refused the expansion, compared to those that implemented it. Backing up to the bigger picture, the best estimates suggest that if 20 million people lose health insurance (an underestimate for this bill), 24,000 will die unnecessarily.
If you’d like an in-depth look at everything in the bill, the best rundown is this one from Vox. The bill, with no CBO score and late-last-night amendments that representatives haven’t necessarily gotten a chance to read, is reportedly up for a vote at 2pm Eastern today. Are they calling our bluff again? Hard to tell, but give your representative a call anyway.