Over 13 million to lose health insurance under GOP plan

Mandatory work requirements; reduced Obamacare subsidies; purging DACA recipients: and new cost-sharing for near-poor beneficiaries included in the bill.

The House leadership late Sunday released the GOP’s plan for cutting health care spending to pay for tax breaks for the rich and large corporations. It whacks both Medicaid and the expanded subsidies that make individual plans sold on the Obamacare exchanges affordable.

While they pitched their plan as a modest program designed to appeal to Republican moderates, there is no way they can generate more than $700 billion in savings without making major cuts to both programs.

Mainstream media coverage is aiding and abetting the subterfuge. “Republicans Propose Paring Medicaid Coverage but Steer Clear of Deeper Cuts,” the New York Times online headline read this morning. “House bill includes work requirements but not deeper reductions some fiscal hawks demanded,” the subhead in the Wall Street Journal read.

Using Congresstional Budget Office estimates, Democrats on Capitol Hill immediately released an analysis that showed 4.2 million people will lose Obamacare coverage over the next decade under the plan. It is largely due to expiration of the expanded premium tax credits passed in 2022 that made the plans affordable for millions.

Another estimated 1.8 million people will lose coverage through new rules making it harder to enroll. The bill calls for shortening the enrollment period, demands more income verification paperwork and excludes non-citizens from the program.

The Medicaid cuts would go deeper, driving an estimated 7.7 million people from the rolls. The GOP bill includes a moratorium on Biden-era rules for streamlining the enrollment process; an 80-hour monthly work requirement (unless you’re a student or pregnant); a monthly redetermination process for eligibility; and denies enrollment to non-citizens without “satisfactory immigration status.” The latter provision eliminates so-called dreamers (Deferred Action for Childhood Arrivals) from qualifying for the program.

Very few people on Medicaid are able-boded, working age adults who are unemployed. Work requirements are not designed to help them find work; they are meant to drive people from the rolls through increased paperwork for the already employed, which is more than half of all working age recipients.

The combined effects of those changes will drive the uninsured rate back into double digits — possibly as high as one in every eight Americans.

There’s more. The proposal, which will be marked up in the House tomorrow, eliminates the 90% federal match for the nine states that have yet to expand Medicaid under the Affordable Care Act, which allows individuals earning up to 138% of the federal poverty line to qualify for the program. It also gives states the right to impose up to a $35 co-pay for every service (capped at 5% of income), which will discourage many people from signing up and discourage those already in the program from seeking health care when they need it.

Little room to lose votes

With narrow majorities in both houses, the Trump-loyal GOP leadership can’t afford to lose many votes. It’s questionable whether the proposed plan will mollify Republican representatives in swing districts or Senators from conservative states that have come around to embracing Obamacare’s health coverage expansion.

On the same day the House plan was released, Sen. Josh Hawley (R-Mo.) wrote on the op-ed page of the New York Times that “slashing health insurance for the working poor … is both morally wrong and politically suicidal.” In August 2020, Missouri voted by a 53% to 47% margin to enshrine expanding Medicaid under Obamacare in its state constitution over the objections of the state’s GOP leadership.

Nor are the MAGA-aimed dogwhistles in the bill likely to mollify the dominant extreme rightwing of the party, which is seeking deep cuts in Medicaid and exchange plans. The proposal prohibits Medicaid, CHIP or Obamacare plans from covering gender transition procedures for minors. It also sunsets the 90% federal match for the nine states that have yet to expand Medicaid to cover people earning up to 138% of poverty, all but assuring that those states, mostly in the deep South, will remain outliers in denying the working poor coverage.

In true GOP fashion, there are several provisions in the bill aimed at appeasing corporate lobbyists and their employers. The bill repeals the rule passed by the Biden administration that requires minimum staff-to-patient ratios in the nation’s nursing homes. It also reins in the middleman charges that pharmacy benefit managers lard onto prescription drug costs. It allows insurance companies to deny future coverage to anyone who once fell behind on their exchange plan premiums. And it further delays cuts in the extra payments some hospitals receive for serving a disproportionate share of the poor.

What’s noticeably absent from the bill is any effort to limit insurance companies’ upcoding in Medicare Advantage plans, which costs taxpayers as much as $80 billion a year. Simply paying MA plans the same amount as their members would cost had they remained in traditional Medicare would save more money over the next decade than all the provisions in the bill released Sunday combined.