By Mayor Jonathan Rothschild, Special to the Arizona Daily Star
“Repeal and replace” was the slogan, but now we’ve seen the House and Senate health-care bills, “wreck and redistribute” is more like it. Almost 45% of nearly $1 trillion in tax cuts would go to the richest 1%—households making $875,000 or more. For that, millions of Americans would lose their health insurance.
The Congressional Budget Office estimates that 23 million Americans would lose health insurance under the House bill and 22 million Americans would lose health insurance under the Senate bill. There’s a word for policies like this: mean.
It gets meaner if you’re older. The Senate bill would allow insurers to charge older customers up to five times more than younger customers.
You’d pay more, but you’d get less. Under current law, a benchmark plan covers 70% of health-care costs. Under the Senate bill, a benchmark plan would cover just 58% of costs. The rest you’d pay out of pocket.
Many hoped the Senate would moderate the House bill. They’ve been sorely disappointed. Like the House bill, the Senate bill would reduce tax credits that help people afford insurance premiums. Like the House bill, the Senate bill would refuse to pay for cancer screenings, family planning and reproductive health care at Planned Parenthood. And like the House bill, the Senate bill would let states decide what insurance plans have to cover as essential health benefits.
Under current law, essential health benefits include hospital stays, prescription drugs, maternity, substance abuse and mental health care, and more. Under both the House and Senate bills, states could remove any or all of these from the list of essential health benefits.
Let’s look at the risk this creates for everyone, wherever they get their insurance.
While the Senate bill prohibits insurers from denying coverage or increasing premiums based on preexisting conditions, people could still be priced out of coverage if states drop items they need from the list of essential health benefits. Why? Because annual and lifetime caps can apply to non-essential health benefits. A cancer patient who needs life-saving drugs could find that prescription drugs are not covered under their plan or, if they are covered, that they’re subject to annual or lifetime limits—just like before the Affordable Care Act.
And finally, Medicaid—a program that has served millions of Americans for more than 50 years—is also being targeted by Congress. The Senate bill would cut federal Medicaid funding by 26%, costing Arizona at least $7.1 billion through 2026.
One in four Arizonans relies on Medicaid. Nationally, 60% of Medicaid funding goes to seniors—many of them in nursing homes—and people with disabilities. Nearly 40% of all children in this country are covered under Medicaid (called AHCCCS in Arizona) or CHIP, the Children’s Health Insurance Program (called KidsCare in Arizona).
Both the House and Senate bills would change Medicaid to a per capita amount or block grant program. This means that, as costs exceed that amount, states have a choice. They can make up the difference with their own tax dollars, or they can cut costs by eliminating services, paying providers less, restricting eligibility, or all of the above.
The funding shortfall gets worse over time. Starting in 2025, the Senate bill would link Medicaid’s funding increase for inflation to the general Consumer Price Index instead of the medical Consumer Price Index. Health-care costs go up much faster than the rest of the economy, so more costs would shift to states over time.
The Affordable Care Act passed after exhaustive public outreach and input, many hearings and much debate. Once it became law, I worked with a coalition of partners to get more Tucsonans enrolled in health-care coverage, and Pima County’s uninsured rate went from 17% to 11% in just three years.
Congress could take steps to build on this success, to make health care better for everyone. The bills they’re proposing, however, do the opposite. Please contact your representatives in the House and Senate and urge them to vote no on these bills.