For some 7 years now, all we’ve been hearing from the GOP is that Obamacare (aka PPACA- the Patient Protection and Affordable Care Act, aka ACA) is horrendous, it’s failing, and it must be repealed. But, we’ve seen what the House GOP produced-  and now the Senate GOP has just proved that they can produce something worse that Obamacare. MUCH, MUCH, Worse.

First of all, their program (The Better Care Reconciliation Act of 2017- I kid you not!)  is not really meant to provide healthcare insurance. This act is  simply a vehicle to provide tax reductions for the rich- at the expense of the poor and the middle class. Robin Hood in reverse.

Why would I say that?

The Senate GOP plan-  crafted by Mitch McConnell in secret, even from his own party- retroactively removes the Medicare 3% surcharge, as well as  the 3.9% capital gains surcharge- for those making significant change (that’s taxable, not gross income).   (As an aside, you can be pretty sure these rich folks won’t be spending that money, so it won’t lead to any economic growth, either.) And, where does one find this tax reduction for the rich?  Right smack in the middle of page 1 of the plan. Why beat around the bush?

This tax cut will return some $ 54+K to US citizens whose taxable income is $ 1 million or more (that’s the average amount), almost $ 5K (again, on average) to those with taxable income of $ 1/2 million, and all of $ 500 to those making $ 200K or more. How much money does this provide to the rich? More than $ 600 billion dollars. More than 3 % of our GDP.    Almost the entire Medicare budget. And, about the same for the US Medicaid expenses.

So, it’s no surprise that the Medicaid portion of Obamacare is being gutted. Oh, wait. Yes, we wait because… The GOP plan waits to gut the Medicaid portion right after 2018. So, they can skate through the next election without folks realizing they’ve been had.

By now, you realize that the proposed plan is, as I said, really a tax cut program. Not a health care program. After all, they’ve killed the individual mandate. I know a lot of people didn’t like that portion of the program- but the GOP plan assumes that by making those who wait until the last minute to purchase insurance to pay more money will make their plan work. That really remains to be seen. (After all, the GOP plan also lets states cut the essential services to be provided by health insurance, which will greatly affect the coverage. See below for more on this ‘wrinkle’.)

Let us also not forget that 65% of folks in nursing homes are able to do so because Medicaid pays their tab. Since long term care is cut by the GOP plan, this entire program will end. Oh, and the GOP plan cuts the Medicaid mandate to cover the disabled and the mentally ill.  Great- this simply means we’ll have more homeless, sick folks on the streets pretty soon.

The act does  still subsidize those who can’t afford insurance- except the definition of who can and can’t afford insurance is radically changed. Oh, and the subsidies all terminate in 2020. So, that more of our working poor will find themselves shut out of real health insurance.

And, I have to wink when I say this bill provides real health insurance. Because the GOP plan changes the definition of health care provisions dramatically. Leaving many of our folks with pre-existing conditions with plans that won’t cover their prescriptions, radiology exams, and the like. (Yes, lifetime caps will also be employed, like those that existed before Obamacare.)

This also explains why the Congressional Budget Office (CBO) predicts that health insurance premiums will decrease between 2020 and 2026. (Note:  This assumes that insurance companies do not alter their definition of reasonable profits; under PPACA that is a regulated item; not true for either the House or Senate plans, so the promise is a little weak.)   Why will the premiums decrease after increasing by 20% a year until 2020?  Because the baseline insurance (currently that’s the PPACA Silver Plan) will no longer cover 70% of costs, but only 58%.  Which means out-of-pocket expenses will more than eat up the future lower premium (if it even happens).

The estimates also assume more younger folks are buying insurance.  After all, for those over 40, the rules that insurance companies can charge no more than thrice (3X) the rate for those under 30 have been ‘relaxed’. The multiples are now 5X. (Don’t forget- the subsidies are also cut, so it’s a double whammy.)  A 50 year old (earning some $ 55K a year) who paid $ 6800 under Obamacare will now have to pay $20500 for lesser insurance. (Sure, they would- they’d spend 40% of their income on insurance- not counting their out-of-pocket expenses. )

There’s more.  The employer mandate has been eliminated. And, that means, as had been true for the decade before Obamacare was the law of the land, more and more employers will cut insurance benefits or terminate their employee’s health insurance completely.

And, for the pièce de résistance… The GOP eliminates all funding of Planned Parenthood. Despite the fact that they are the prime agency to screen for sexually transmitted diseases and handle the gynecological needs of the poor (75% of Planned Parenthood services cover those at the poverty line- or less than 50% above it). So, this compounds the hurt to our lower income folks, as least as much as those Medicaid cuts.

Yup. The GOP plan has heart.

As long as yours is black.