SAN FRANCISCO, CA - JUNE 21:  Healthcare activists hold headstones as they stage a die-in while protesting the Trumpcare bill on June 21, 2017 in San Francisco, California. Dozens of healthcare activists and senior citizens staged a protest outside the San Francisco Federal Building to express their opposition of the American Heathcare Act bill that is being drafted behind closed doors by Republican senators.  (Photo by Justin Sullivan/Getty Images)

Popular vote loser Donald Trump freely admits he called the House version of Trumpcare “mean, mean, mean” and also claimed that he wanted a Senate bill that is “generous, kind, with heart.” That’s not what he got with the Senate version of Trumpcare, the “Better Care Act.” In fact, the Congressional Budget Office says it’s just as mean by the numbers, if not more so.

According to their estimates, 15 million people will lose their insurance next year, 2018. An election year. By 2026, 22 million people who are now insured will have lost that insurance. Compared to the Affordable Care Act, “an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.” The biggest hit, as in the House bill, lands on Medicaid.

The largest savings would come from reductions in outlays for Medicaid—spending on the program would decline in 2026 by 26 percent in comparison with what CBO projects under current law—and from changes to the Affordable Care Act’s (ACA’s) subsidies for nongroup health insurance. Those savings would be partially offset by the effects of other changes to the ACA’s provisions dealing with insurance coverage: additional spending designed to reduce premiums and a reduction in revenues from repealing penalties on employers who do not offer insurance and on people who do not purchase insurance. […]

In later years, other changes in the legislation—lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market—would also lead to increases in the number of people without health insurance.

Keep in mind that “later years” part. This estimate doesn’t go beyond 2026; however the CBO doesn’t think that the so-called “flexibility” for Medicaid that block granting would be for states is all that. Instead, it would be a burden. “With less federal reimbursement for Medicaid, states would need to decide whether to commit more of their own resources to finance the program at current-law levels or to reduce spending by cutting payments to health care providers and health plans, eliminating optional services, restricting eligibility for enrollment through work requirements and other changes, or (to the extent feasible) arriving at more efficient methods for delivering services.” It also projects that post-2026, Medicaid enrollments would continue to fall.


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