Ruthless, Soulless, Vicious: Three Reasons the Senate GOP's ACA Replacement Is a Disgrace

Senate Majority Leader Mitch McConnell departs a closed-door meeting on Capitol Hill, in Washington, DC, June 22, 2017. Senate Republicans took a major step Thursday toward repealing and replacing the Affordable Care Act, unveiling a bill that would make deep cuts to Medicaid and leave possibly millions of people without health insurance. (Photo: Doug Mills / The New York Times)

"The Better Care Reconciliation Act is a genuinely cruel piece of work that will deliver millions of people to the gutter or the grave... Medicaid itself will essentially cease to exist after 2025."

 By William Rivers Pitt, Truthout 

The Senate's answer to the House bill to repeal the Affordable Care Act -- cheerily titled "The Better Care Reconciliation Act of 2017" -- hit my desk like a bag of dung late Thursday morning. As I read through its largely inscrutable text, I started flashing back to junior high school and the first time I tried to read Shakespeare in the raw. Take, for one example, this nugget from p. 74, sec. 1903A, lines 18-24: "1903A ENROLLEE. -- The term '1903A enrollee' means, with respect to a State and a month and subject to subsection (i)(1)(B), any Medicaid enrollee (as defined in paragraph (3)) for the month, other than such an enrollee who for such month is in any of the following categories of excluded individuals …"

Clear as mud, Mr. McConnell. After a couple of false starts, I found my groove and with slowly dawning horror realized I was reading one of the most ruthless, soulless, vicious documents ever put to print. While not as bloodthirsty as the House version it seeks to correct, the Better Care Reconciliation Act is a genuinely cruel piece of work that will deliver millions of people to the gutter or the grave.

1. The Dismantling of Medicaid

Let's start with a baseline: Some 20 percent of Americans are enrolled in Medicaid; 39 percent of children in the US are enrolled in Medicaid; 49 percent of births are covered by Medicaid; and a full 64 percent, or nearly two-thirds of nursing home patients, are covered by Medicaid.

Here's the treatment Medicaid gets in this reconciliation bill: "Beginning with fiscal year 2020, any State (as defined in subsection (e)) that has an application approved by the Secretary under subsection (b) may conduct a Medicaid Flexibility Program to provide targeted health assistance to program enrollees."

And: ''(A) FEDERAL PAYMENT. -- Subject to sub-paragraph (D), the Secretary shall pay to each State conducting a Medicaid Flexibility Program under this section for a fiscal year, from its block grant amount under paragraph (2) for such year, an amount for each quarter of such year equal to the Federal average medical assistance percentage (as defined in section 1903A(a)(4)) of the total amount expended under the program during such quarter, and the State is responsible for the balance of the funds to carry out such program."

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