We now know why Senate Republicans cloaked their version of the healthcare bill in secrecy and dishonesty, and why they now want to rush the bill to the Senate floor for a vote with no committee hearings and no public testimony.
When it comes to the Better Care Reconciliation Act, if you’re a member of the 1%, a corporation, or a shareholder in the pharmaceutical or healthcare industries, you’re in luck. If, on the other hand, you need access to quality, affordable healthcare, or a functioning public health infrastructure that prevents illness and injury, or resources to help your community become a safer, more equitable place to live, well, this bill wasn’t written for you.
The Congressional Budget Office projects that 22 million people would lose healthcare coverage if the BRCA becomes law, and strip away billions in funding for public health and prevention. Those who stand to lose the most if the bill passes are those communities that have the least ground to lose.
The biggest changes the BRCA would make to healthcare access in the US are the changes to Medicaid. If signed into law, the Senate bill would dismantle Medicaid as we know it. Medicaid – which covers over 74 million low-income Americans, including elderly people and people with disabilities – has always operated as a shared effort between states and the federal government that could respond with increased resources when need increased. The Senate bill would place a per-capita cap on federal Medicaid spending, and offer states the even more drastic option of block-granting Medicaid, which would give states almost total control over how the program is administered within their borders, opening the door to work requirements, and even deeper cuts to which populations and what services are covered. The bill also phases out the Medicaid expansion that has extended healthcare coverage to over 14.5 million people. In eight states with “trigger laws” – Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico, and Washington – people who’ve gained coverage through the Medicaid expansion will lose their healthcare the moment federal funding starts to decrease. The bottom line? This fundamental change in the way Medicaid operates will starve states to the tune of $772 billion in funding over the next 10 years. The American Academy of Pediatrics slammed the bill for “forc[ing] states to make decisions about which vulnerable population gets services.”
Such deep cuts to Medicaid will only fuel the opioid crisis raging in communities across the US, as will the bill’s option for states to waive regulations that require insurers to cover mental health and substance abuse treatment. In return, the Better Care Reconciliation Act would supply only a fig leaf of support to fund treatment and recovery services: one year of funding at $2 billion. Instead of getting ahead of the epidemic by investing in prevention, the Senate bill will drain the resources needed to save lives.
And at a time when maternal mortality – especially among African-American women – is on the rise, the bill would harm the health of women and children in three distinct ways: by allowing states to opt out of requiring coverage of Essential Health Benefits like maternity care and birth control; by gutting Medicaid, which currently covers roughly half of all births in the US; and by suspending all federal funding to Planned Parenthood for one year, a provider that one in five women rely on to meet their basic healthcare needs.
So far, most of the conversation around healthcare has focused downstream” at the effects the bill will have on healthcare access and services. When we turn our attention “upstream” toward the resources and programs that help people stay healthy and safe in the first place, we find no relief – the future is grim. Instead of investing in the community-based resources that support health and equity, the BRCA would zero out the Prevention and Public Health Fund and drain funds from the Centers for Disease Control and Prevention. Rolling back these vital investments in public health will mean more suffering, more premature death, and higher healthcare costs from preventable illnesses and injuries. The BRCA pulls these hopes and plans for a brighter future up by the roots, and sows the ground with salt.
This bill pays for tax cuts with people’s lives and preventable suffering, and sacrifices the wellbeing of the next generation, especially children growing up in poverty and children with special healthcare needs, to line the pockets of the wealthy. The cuts this bill proposes – to Medicaid, to public health and prevention – would touch every community, especially those communities that are struggling most with longstanding inequities in health and safety, structural racism, and economic disinvestment.