Editorial Board

Different CBO Score, Same Result

The Republican effort to repeal and replace Obamacare is as indefensible in the Senate as it was in the House.

Why is this man smiling?

Photographer: Mark Wilson/Getty Images

The Senate legislation to "repeal and replace" the Affordable Care Act was drafted in secret under the guidance of Senate Majority Leader Mitch McConnell. Now the Congressional Budget Office has let this cat out of the bag.

The CBO and the Joint Committee on Taxation on Monday released their analysis of the Republican Senate bill, and it is no less devastating for being entirely predictable. To fund the bill's tax cuts for insurers as well as the wealthiest Americans, the health insurance of 22 million Americans would be sacrificed by 2026.

In the end, McConnell's closed-door machinations produced a bill no better than the reckless effort of House Republicans, which the CBO predicted would cause 23 million to lose health insurance over the next decade. With numbers that large, and damage that immense, what's a million here or there?

Senate leaders can be expected to make changes to their bill over the next few days in an attempt to make it less "mean," President Donald Trump's adjective for the House bill. In fact the process has already begun, and the results are not encouraging. One new provision, for example, would allow insurers to punish people who let their coverage lapse for as few as 63 days -- by making them wait six months for new coverage.

This amendment is worse than inadequate as a replacement for Obamacare's individual mandate, which is a way to make sure people don't wait until they're sick to enter the market. It could actually discourage people from buying insurance altogether: If you're healthy, why pay for something that you can't even use for six months? And if you're sick, that six-month wait could be miserable, even fatal.

Nor does the change address the place where the Senate bill does most of its harm -- with cuts in Medicaid. In addition to providing insurance to millions of children and poor adults, the program helps support nearly 1 million residents of nursing homes.

It's worth recalling how such legislation even came to exist. The Affordable Care Act raised taxes on the wealthiest Americans to fund a vast expansion of Medicaid and subsidies for health insurance for poor and middle-class Americans. Because health care is expensive (especially for the sick), health insurance is likewise expensive (especially for the sick). The ACA made insurance, and thus care, newly accessible to some 20 million.

Republicans in the House and Senate now wish to rescind that access, and transfer the funds to wealthy taxpayers. Their plans will make America sicker while making the richest a bit richer. No Republican leader has been willing to acknowledge that fact, let alone justify it. It's a charade that offends decency as well as common sense.

    --Editors: Francis Wilkinson, Michael Newman.

    To contact the senior editor responsible for Bloomberg View’s editorials: David Shipley at davidshipley@bloomberg.net .

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