The New Trumpcare Bill Keeps the Single Cruelest Part of the Old Trumpcare Bill

Ian Millhiser

Ian Millhiser Senior Constitutional Policy Analyst, Think Progress

Senate Majority Leader Mitch McConnell (R-KY) is fighting a two front war. At the right end of his caucus, hardliners want deep Medicaid cuts and weaker protections for people with preexisting conditions. More pragmatic conservatives, meanwhile, say they want to keep the legislation from working havoc on Medicaid.

If a new version of the Senate Republican health bill is any indication, however, McConnell’s strategy is to placate the hardliners and ignore the relatively moderate voices within his caucus.

Though the new draft version of Trumpcare, which was released on Thursday, does make some tweaks to the previous bill’s approach to Medicaid, it largely leaves in place a plan that would eventually phase out Medicaid in its entirety.

Medicaid serves nearly 75 million individuals, most of them drawn from very vulnerable populations such as the poor, the aged, and the disabled.

The new Trumpcare bill, like the one McConnell released last month, imposes caps on Medicaid spending. And the caps effectively lose value with each passing year.

The Congressional Budget Office (CBO) predicts that the cost of care for an individual Medicaid beneficiary will increase 4.4 percent each year. Beginning in 2025, however, the Senate’s version of Trumpcare provides that the Medicaid caps will only grow at the rate of general inflation — closer to 2.4 percent per year. Thus, while the absolute number of dollars spent by Medicaid will increase each year, the real value of that spending will diminish more and more with each passing year.

CBO predicted that the previous version of the Senate Trumpcare bill, which also used a similar mechanism to phase out Medicaid, would cut Medicaid by 35 percent by 2036 relative to current law.

In fairness, there are some new provisions included in the new bill that mitigate the impact of the legislation in the short term. One provision, for example, allows the Medicaid caps to be exceeded in the event of a public health emergency — although this provision sunsets fairly rapidly.

But the basic structure of the earlier bill, with its Medicaid phase out, remains intact.

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Reposted from ThinkProgress

Ian Millhiser is a Senior Constitutional Policy Analyst at the Center for American Progress Action Fund and the Editor of ThinkProgress Justice. He received a B.A. in Philosophy from Kenyon College and a J.D., magna cum laude, from Duke University. Ian clerked for Judge Eric L. Clay of the United States Court of Appeals for the Sixth Circuit, and has worked as an attorney with the National Senior Citizens Law Center’s Federal Rights Project, as Assistant Director for Communications with the American Constitution Society, and as a Teach For America teacher in the Mississippi Delta. His writings have appeared in a diversity of legal and mainstream publications, including the New York Times, The Los Angeles Times, U.S. News and World Report, Slate, the Guardian, the American Prospect, the Yale Law and Policy Review and the Duke Law Journal; and he has been a guest on CNN, MSNBC, Al Jazeera English, Fox News and many radio shows.

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Union Matters

Biden His Time

On May 2, 2011, hours before I underwent brain surgery, news broke that Osama bin Laden had been killed by Navy Seals. “At least I outlived you, you son of a bitch!”

Sitting up, I had accidentally pulled several EEG leads loose from my partially shaved head. An alarm sounded. I apologized to the responding nurses.

I described that moment to Beau Biden a year later, after he led a group of veterans marching in a Fayetteville, North Carolina voter registration drive.

I was still catching my breath and wiping my brow when the Vice President’s son walked over and asked if I was doing alright.

“Yes sir, I’m fine, thank you.” Sketching a salute with my walking stick, I said, “We’ve got other things in common besides we’re both voting for your dad.”

“Is that right?”

“Yes sir. We both served in Iraq—and we both battled brain illness afterwards.”

“And here we still are.” Biden smiled and the genuineness of his expression touched my heart.

I offered a quick account of my medical marathon, including the night bin Laden’s death cheered me up, then identified myself as a 2012 Obama organizing fellowship selectee. I expressed my regret that due to medical setbacks I wasn’t able to do more for the campaign.

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Today, and Every Day

Today, and Every Day