Opinion: The Senate health bill: too hot, too cold, or just right?

AP Photo / J. Scott Applewhite

Senate leaders released their draft of a health-reform bill today, and you can go ahead and discount about half of the responses. By that I mean: If you believe there is always more money to be taxed from “the rich” and spent on government programs (which abso-definitely work just great, and very certainly, for sure, don’t result in a) Medicaid patients having trouble finding actual doctors who will see them, and b) Obamacare-plan consumers finally being able to afford premiums, only to learn they can’t afford their deductibles and are actually no better off) then you were not going to like anything a GOP Congress came up with. Period. Your version of health reform was tried, found lacking, and rejected at the ballot box in 2010, 2014 and, finally, 2016.

With that out of the way … the big question all along was whether Republican senators had the nerve to pass a bill that would try something very different from that approach. In the Democrats’ manichean view, there is only Obamacare or what existed before Obamacare; repealing and replacing Obamacare thus necessarily means going back to the status quo ante. This is one of many things they’re wrong about when it comes to health care. What existed before Obamacare was not “free market” health care. We haven’t had a free market in health care in decades, if ever. And let’s face it, a pure or maybe even predominantly free-market approach isn’t going to happen anytime soon, because the health-care market is so distorted at this point it’s hard to even know what that would look like. But a bill decisively more free-market in its approach would actually stand a chance of lowering costs (premiums and deductibles on the insurance side, and prices for services from providers) and eventually covering far more people.

Is that what we got?

Hard to say. The 142-page bill was just released a few hours ago, and it includes so many cross-references to existing statute that it’s difficult to immediately pin down everything it does. But here’s one first take from a Republican health analyst whose opinion I’ve come to value:

That’s a big statement from someone I don’t find to be prone to hyperbole.

One certainty is that it is not a pure repeal-and-replace bill. But we knew that going in: Reconciliation, the budget process the Senate is using on health care due to 100 percent Democratic opposition, has its limits. Because so much of what’s called “Obamacare” is actually federal regulation authorized by that law, much change will have to come through the regulatory process now led by Georgia’s Tom Price. What this bill can do is change taxation and spending.

It does the former in a much bigger way than the latter. The bill repeals a host of Obamacare taxes. It improves the tax treatment of important tools such as Health Savings Accounts and raises limits on contributions to them. Small businesses and their employees also appear to gain some important options in how they offer and buy health insurance.

As for spending, the subsidies for lower-income Americans are expanded down the income scale. They began at 100 percent of the federal poverty level (FPL) under Obamacare, which assumed everyone below that level would be covered by Medicaid, and ended at 400 percent. The new Senate bill instead offers subsidies via tax credits to everyone earning less than 350 percent. That’s more people on the lower end, but fewer people on the upper end (for reference, 350 percent of FPL this year starts at $42,210 for an individual and $86,100 for a family of four; 400 percent starts at $48,240 for an individual, $98,400 for a family of four).

Many of the bill’s changes to spending on programs such as Medicaid are phased in between 2021 and 2025. One supposes there are three reasons for this: to keep moderate Republicans on board, to postpone most of the changes until after the current president’s re-election campaign (a la Obamacare), and to provide some time for the market to adjust to the new realities the bill imposes. The bill seems to both anticipate and seek to mitigate growing pains.

But will people react to the stick while they’re still being fed carrots? Given all that has happened in the health-care market over the past decade, one could imagine providers, insurers and consumers alike being hesitant to make big changes, with the expectation that, as with Obamacare, things will change along the way — sometimes in large ways.

There’s a balance to be struck here between getting things moving and not having them move so quickly as to leave people feeling unsettled. That balance may not be just right in this bill. In fact, I expect that is where the more conservative senators will try to change things in the negotiations referenced here:

Those aren’t the stiffest of objections: “currently … not ready … open to negotiation …” And if there’s to be some stagecraft involved in this process, having the bill evolve a bit to assuage the conservatives’ concerns, rather than vice versa, is probably good politics for Mitch McConnell.

***

ADDED at 4:22 p.m.: And to the Republicans’ rescue comes … Barack Obama?

The former president, who didn’t have to deal with his predecessor sniping at him from the sidelines, weighed in on the Senate bill today with a lengthy Facebook post. It has all the use of strawmen and selective facts we came to expect from him. (Did you know Republicans “f[ought] for the Affordable Care Act for more than a year in the public square”? Because I don’t remember that.) He even cites the Congressional Budget Office’s analysis of the House bill in his rant against the Senate draft.

But where he really goes full-tilt progressivist — and possibly gives the GOP an argument, if they know how to recognize one — is when he writes: “The Senate bill, unveiled today, is … a massive transfer of wealth from middle-class and poor families to the richest people in America.”

This is an apparent article of faith on the left — you can find others writing the same thing — but it is truly through the looking glass. First, a “massive transfer of wealth” is explicitly what Obamacare was. Its entire purpose was to take money from some people (exactly whom, I’ll address in a moment) and spend it on others — namely, to help them purchase plans that a) doubled in price within four years; b) saw skyrocketing deductibles that undermined the economic value of having a plan for most of them; and c) continue to shrink in availability. The Senate bill undoes what Obamacare did, which is to say, it lets people keep their money rather than having it transferred to others. But to Obama, undoing that transfer is the transfer. Unbelievable.

Second, this transfer was from whom, exactly? I understand it is also an article of faith on the left that companies, not people, pay business taxes, but that simply isn’t true. Business taxes result in some combination of the following: less wealth for shareholders; lower wages for employees; higher prices for consumers. There is no fourth option. Perhaps Obama doesn’t care about the first of those, but the other two ought to matter. And consider what the taxes to be repealed cover (as they’re listed in the Senate bill):

  • Repeal of the tax on employee health insurance premiums and health plan benefits
  • Repeal of tax on over-the-counter medications
  • Repeal of tax on health savings accounts
  • Repeal of tax on prescription medications
  • Repeal of medical device excise tax
  • Repeal of health insurance tax
  • Repeal of chronic care tax
  • Repeal of Medicare tax increase
  • Repeal of tanning tax
  • Repeal of net investment tax

Of those 10, only the last could reasonably be construed to affect primarily high-income Americans — and even that requires us to ignore that many middle-income Americans also have investments. Otherwise, who pays OTC medications and prescription medications? Who buys medical devices and insurance? Who uses tanning beds? Not only, or even mostly, “the rich.” If Republicans are smart (big “if”) they’ll be happy to join this argument with the ex-president.

Reader Comments 0

359 comments
SGTGrit
SGTGrit

The daytime kooks have made their presence but like the evening kooks they fall far short.

McGarnagle
McGarnagle

"The Senate bill undoes what Obamacare did, which is to say, it lets people keep their money rather than having it transferred to others"


This all goes back to the question of universal healthcare and whether healthcare is a right or privilege in this country? Once we answer those questions, Obamacare makes sense or it doesn't.

MarkVV
MarkVV

It is quite incredible that Kyle would try to resurrect that ancient slogan that companies do not pay business taxes.

MarkVV
MarkVV

Kyle: “ But to Obama, undoing that transfer is the transfer. Unbelievable.

Kyle has the right to his beliefs. But just like one has the right to opinions, but no facts, so the right to beliefs is not right to facts. And the fact is that the proposed elimination of the ACA 3.8 percent net investment tax would be a massive transfer of wealth, just as Obama said. Whether it reverses another transfer is immaterial.

AvgGeorgian
AvgGeorgian

Kyle assumes as republicans always do that any tax must be passed on to the consumer and never paid for with profits. he also assumes that there is no market effect to passing on extra costs to consumers. Kinda weird.

Robert1959
Robert1959

Kyle, after reading your article none of your hardcore (racist and bigots) readers can comprehend what you have written.  Please try to explain to them in plain old southern hillbilly talk (goosh, willy nilly, moochers, hotdiggy, obummer, etc.). 
Kyle, some Georgians do not understand you are part of the media and your articles are "alternate facts" and "fake news".  That is why the AJC pays your salary.  lol...

MarkVV
MarkVV

Kyle: “Of those 10, only the last could reasonably be construed to affect primarily high-income Americans — and even that requires us to ignore that many middle-income Americans also have investments.

Middle-income Americans? Does Kyle consider those making $200,000 a year ($250,000 for couples) “many middle income Americans?"

Robert1959
Robert1959

Kyle, even alt-rightwing extremist and lunatics who read your articles must face the "truth" and reject this latest attempt by America's homegrown terrorist/Russian comrades/GOP to repeal and replace the Affordable Care Act (ACA). The GOP has failed over 50+ times. 

JohnnyReb
JohnnyReb

@Robert1959

You'll have better luck getting someone to agree with your trash at Bookman's.

Robert1959
Robert1959

@JohnnyReb I believe in saving 1 Soul at a time.  When will you "face the "truth" and reject this latest attempt by America's homegrown terrorist/Russian comrades/GOP"?

SGTGrit
SGTGrit

Things are looking much better now than the malaise that covered America during the last eight years. The business community has renewed confidence since the President rolled back onerous regulations that had been stifling economic growth. We're seeing job growth that we haven't seen in a long time. Food stamp use is in steep decline. It appears that a replacement for the failing Obamacare debacle is close to realization and tax reform is possible this year. We're regaining our leadership in the world and our adversaries know that United States can no longer be cowered. All in all a pretty good job for the first half of a presidents first year in office.

Hedley_Lammar
Hedley_Lammar

@SGTGrit None of that is even close to reality.


GDP growth is the same as it was under Obama. And Trumpcare is going to be a total disaster. If they pass it which is still far from a done deal.


We have forfeited our leadership role  in the world. Angela Merkel is now widely considered the leader of the free world.


The birther liar certainly isnt. 

SGTGrit
SGTGrit

@Hedley_Lammar @SGTGrit  Still whining your oss off. Angela Merkel is hardly the free worlds leader she can't even govern Germany effectively. The German people are fed up with her. Everything In said above is fact you just don't like the facts.

JohnnyReb
JohnnyReb

Do the LibProgs posting "tax cuts for the rich" know what they write or are they simply repeating talking points?

About half of wage earners do not pay any federal income tax now.

How much more from the makers do they want to take?

What is a "fair share?"

Is not half of wage earners paying everything grossly past being fair?

And if yes, then how can the Dims say that is not enough?

Hedley_Lammar
Hedley_Lammar

Also notice not one complaint about this bill being written completely behind closed doors.


Unlike the Obamacare debate they complain about so loudly.


Simply amazing. 

Hedley_Lammar
Hedley_Lammar

“I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.”


- Donald Trump

Hedley_Lammar
Hedley_Lammar

800 billion in medicaid cuts. Care for the poor, elderly, and children


800 billion in tax cuts for the wealthy.


It doesnt take Sherlock Holmes to figure this one out. They are taking care from those folks so that Trump can be a little bit richer.

Hedley_Lammar
Hedley_Lammar

 If the Dems did not have a victim class, they would have nothing.


Oh the irony.

breckenridge
breckenridge

@Hedley_Lammar 

At least the dems aren't being persecuted for their Christian beliefs!

bwwwwwwwwwahhhhhhhhhhhhhhh

Hedley_Lammar
Hedley_Lammar

 The former president, who didn’t have to deal with his predecessor sniping at him from the sidelines


Because of his incredible unpopularity. 

breckenridge
breckenridge

Johnny Reb we need some righteous indignation from you today.  The question is how to get you there.


(hint: Google Johnny Depp)

JohnnyReb
JohnnyReb

@breckenridge

Johnny Depp is a great actor who should learn what not to say.  He can expect a visit from the Secret Service.

It's your problem when you perceive truth that I post as indignation.

If the Dems did not have a victim class, they would have nothing.

You probably have not noticed that.

Everything out of their mouths is to blame someone else for the problems of their victims.

AvgGeorgian
AvgGeorgian

@JohnnyReb @breckenridge

Would the trump supporters that will lose medicaid benefits due to to tax cuts for the rich (in the same bill) be considered the republican victim class?

Kathy
Kathy

Why so much chronic secrecy from the folks who pay their salaries?Congress should have the same health insurance since  its so wonderful. Sitting on the golf course so long they really think we are all stupid enough to believe them.

JohnnyReb
JohnnyReb

@Kathy

Be reminded Congress tried to put the staffers on Obamacare and they revolted.

BuckeyeGa
BuckeyeGa

@JohnnyReb @Kathy  Not sure what you are referring to but that doesn't negate the chronic secrecy addressed in the initial post.

JohnnyReb
JohnnyReb

@BuckeyeGa @JohnnyReb @Kathy

My post was in reference to Kathy stating Congress should have the same insurance, to which I agree.  But the ball-less wonders did not have the courage to put the staffers on Obamacare, much less themselves.

The reason for the secrecy was to avoid bogging down the process.

If they had not used secrecy it would still be in committee.

And, the Senate bill will go to reconciliation with The House, so it's not even close to being the final product.

BuckeyeGa
BuckeyeGa

@JohnnyReb @BuckeyeGa @Kathy  I agree Congress should have the same Healthcare ..As far as bogging down a bill, they weren't worried about that when they wanted Obamacare discussions out in the open(which they were).  They want members to vote on a bill that hasn't been properly reviewed.That bill should be review thoroughly. 

JohnnyReb
JohnnyReb

@BuckeyeGa @JohnnyReb @Kathy

Yes it should be reviewed thoroughly, but no so much in the Senate.

At reconciliation.

Otherwise no chance of passing anything any time soon, which is exactly what the Dems want.

Visual_Cortex
Visual_Cortex

"The government has no money."

That’s one for the RWNJ Hall of Fame.

JohnnyReb
JohnnyReb

@Visual_Cortex

I don't agree with you most of the time, but I do give you credit for being more grounded than most regulars at Bookmans.

When you post something like that, you are lowering yourself to Kamchak level.

It's true the government has no money, it only shuffles the money taken from taxpayers.

Ralph-43
Ralph-43

One more attempt to withdraw from the United States and its founding documents ('Life, Liberty, and the Pursuit of Happiness").  The anti-tax, self-interested, 'strong leader' worshippers should find another country.  Western democracy will survive in the United States and all citizens have the right to life, freedom, and healthy success.

Ralph-43
Ralph-43

@JohnnyReb @Ralph-43  Good luck.  Maybe that Confederate enclave in Brazil will be more to your liking.  You can wear your sheet and hood anytime you want.  I'm sorry Democracy did not work out for you.

Finn-McCool
Finn-McCool

Trump was on Fox and Friends this morning taking credit for the new healthcare draft? Jeez

"I've done more in 5 months on this than most people ever do."

What is really disgusting is that when things work out good, Trump takes credit even if he isn't responsible. When things turn out bad, Trump won't take any responsibility. Man-child.

Manman
Manman

@JohnnyReb @Finn-McCool If Tom Price was going around saying he wasn't allowed to give input then it's a safe bet neither did Trump

JohnnyReb
JohnnyReb

@Manman @JohnnyReb @Finn-McCool

Price does not have the power of the veto.

So to equate the same courtesies given price to those of Trump is a mistake.

Plus, Price knows exactly what is happening.  Many of the changes needed will be by him through administration, not Congress.

ATLAquarius
ATLAquarius

Kyle


We know that you are not for Obamacare....do you endorse the general principles of what the GOP is trying to do? Essentially lower premiums by rescinding what must be covered and also lower the overall amount of public money funding non-employer based healthcare plans? I don't think any plan will work without attacking the cost of healthcare which at some level will require government intervention...I'd love to hear how it happens otherwise and not bumper sticker slogans. Should the profit motive be a part of every level of healthcare....should companies be able to acquire drug patents and dramatically raise the price of the drug for instance? 

Eye wonder
Eye wonder

@ATLAquarius

I'm guessing that because of the tax cut layered on top of a tax cut  tied to a regulation cut and sprinkled with a dollop of right wing religious dogma, Kyle is probably ok with it.

JohnnyReb
JohnnyReb

Republican leadership is stupid.

When it comes to marketing the kid at the lemonade stand on the corner does a better job.

One of them with a set needs to stand up and state this.

The government has no money.  It only has the money taken via taxes from citizens and the money borrowed.

The money borrowed has to be repaid using the taxes from citizens.

Every entitlement - welfare for the challenged - is wealth transfer from those who pay taxes to those who do not.

That includes helping those who cannot afford health insurance to buy it by giving, yes giving them money taken from someone else.

So Dims....

Knock off the stupid lying propaganda about the health care law being wealth transfer to the rich.

That simply is not true.  It's BS being fed you by your failing leadership.

Be happy you get even one dollar given you.....

Because that 50% or so of wage earners who actually pay federal income tax.....

no one is giving them a thing.  They work their a s s off only to have earned money taken from them and given to others.