Senate Majority Leader Mitch McConnell (R-KY) is fighting a two front war. At the right end of his caucus, hardliners want deep Medicaid cuts and weaker protections for people with preexisting conditions. More pragmatic conservatives, meanwhile, say they want to keep the legislation from working havoc on Medicaid.
If a new version of the Senate Republican health bill is any indication, however, McConnell’s strategy is to placate the hardliners and ignore the relatively moderate voices within his caucus.
Though the new draft version of Trumpcare, which was released on Thursday, does make some tweaks to the previous bill’s approach to Medicaid, it largely leaves in place a plan that would eventually phase out Medicaid in its entirety.
Medicaid serves nearly 75 million individuals, most of them drawn from very vulnerable populations such as the poor, the aged, and the disabled.
The new Trumpcare bill, like the one McConnell released last month, imposes caps on Medicaid spending. And the caps effectively lose value with each passing year.
The Congressional Budget Office (CBO) predicts that the cost of care for an individual Medicaid beneficiary will increase 4.4 percent each year. Beginning in 2025, however, the Senate’s version of Trumpcare provides that the Medicaid caps will only grow at the rate of general inflation — closer to 2.4 percent per year. Thus, while the absolute number of dollars spent by Medicaid will increase each year, the real value of that spending will diminish more and more with each passing year.
CBO predicted that the previous version of the Senate Trumpcare bill, which also used a similar mechanism to phase out Medicaid, would cut Medicaid by 35 percent by 2036 relative to current law.
In fairness, there are some new provisions included in the new bill that mitigate the impact of the legislation in the short term. One provision, for example, allows the Medicaid caps to be exceeded in the event of a public health emergency — although this provision sunsets fairly rapidly.
But the basic structure of the earlier bill, with its Medicaid phase out, remains intact.