On Thursday, Senate Majority Leader Mitch McConnell finally released the Senate’s version of the Obamacare repeal bill from its secret crypt.
The Senate bill, renamed the Better Care Reconciliation Act of 2017, is not so much about dismantling the individual health insurance markets set up by the Affordable Care Act as it is gutting Medicaid to subsidize tax cuts for the rich. The Affordable Care Act’s Medicaid provisions expanded coverage for millions of low-income Americans. The Republican health care bill would phase out that funding, starting in 2021, and then fundamentally roll back Medicaid even further.
As Sarah Kliff writes at Vox:
There are significant changes to Medicaid in the Senate bill outside of the expansion too. This bill would convert Medicaid to a “per capita cap” system, where states would get a lump sum from the federal government for each enrollee. Or states would have the opportunity of a block grant — a sum of money untethered from the number of people involved.
This is very different from current Medicaid funding. Right now the federal government has an open-ended commitment to paying all of a Medicaid enrollee’s bills, regardless of how high they go.
In short: The bill, like its predecessor from House Republicans, is an all-out declaration of class warfare of the rich against everyone else. The Senate version of the bill, as a sort of bonus, would also punish Americans who happen to live in particular states.
As Slate’s Jordan Weissman noted:
In English: States that spent more than 25 percent the national average per Medicaid recipient in the previous fiscal year would see federal contributions to their Medicaid budgets cut up to 2 percent. (States that spent less than the average would be rewarded.) The obvious effect of this measure is be to punish blue states, especially those with high urban populations, as most of the states that spend more on Medicaid per recipient than the national average are in the Northeast.
There is a problem with that, though. As Weissmann also noted, this would also punish a few mostly rural states, like Alaska, that are represented by Republicans, whose votes will be needed to pass the bill.
So it simply exempts a few rural states:
(Weissmann calls this, in his own writeup of the provision, the Klondike Kickback.)
In essence, the Senate Republicans who drafted this bill looked at the House’s version and decided that it did not do enough to specifically punish people who live in densely popular and racially diverse regions of the country.
This is policy as done by people whose only goals are political. For Republicans, the point is using any and all legal means necessary to disenfranchise and immiserate anyone who might have voted against you—or, even better, to make it much more difficult for them to stay alive.