By J. Mario Molina
First, the bill destroys Medicaid as we know it. Medicaid serves over 70 million people, including 30 million children, 10 million persons with disabilities, 10 million poor seniors and 20 million working poor and low-wage earners without employer-sponsored insurance. The Senate bill kills this five-decade compact between Congress and the American people to provide a safety net for our most vulnerable citizens in their time of greatest need.
Second, the individual market doesn't fare much better. The Senate bill provides tax credits to help pay for insurance, but fewer people will qualify and less credit will be available to them. Insurance companies will be able to charge older Americans five times more than younger people, making health care less affordable for those mostly likely to need it.
Third, the 10 essential benefits outlined in the Affordable Care Act are not guaranteed in the Senate bill. This means states and insurance carriers could exclude coverage of maternity care, mental health services or treatment for opioid addiction, among other things. The reason that these benefits were enshrined in Obamacare in the first place was to make sure that people didn't buy skimpy policies that did not provide them real coverage when they got sick. (I now envision a future where the insurance company value proposition is "crappy care at a convenient price.")
Fourth, the mandate that everyone must have insurance is gone – but insurance companies won't be able to turn away applicants. It is a little like being able to wait until you smell smoke before buying homeowner's insurance. As a result, individuals buying insurance will have to pay more out of pocket for premiums, and deductibles and co-pays will rise. At the same time, the number of uninsured will increase.
Finally, the wealthy wind up just fine. Health care corporations and individuals earning over $200,000 a year get a tax break amounting to over $170 billion. Looked at another way, in order to give a tax break to 3 million Americans, we have to take health insurance away from more than 24 million people.
