We now know that the revised Senate bill would keep more of the Affordable Care Act’s taxes on the wealthy but it would also allow insurers in the marketplaces to work around some of Obamacare’s more humane and effective regulations — all while keeping the biggest cuts to Medicaid firmly in place. The question now is will moderate Republicans take the bait?

Sen. Ted Cruz’s amendment to the Senate bill shows that the GOP was never really committed to protecting coverage for pre-existing conditions.

The revised Better Care Reconciliation Act reintroduced by Senate Majority Leader Mitch McConnell (R-KY) on Thursday does not differ from the Senate’s previous version of the bill in that it will retain massive cuts to Medicaid and provide less financial aid to people who buy private health insurance in the marketplaces.

The revised plan immediately drew criticism from senators on both sides of the aisle. Even with Vice President Mike Pence poised to cast the deciding vote, Republicans can only afford to lose two votes to clinch passage. All 48 Democratic senators are opposed to the GOP’s repeal and replacement bill.

Failure on the GOP’s top policy priority, despite controlling both chambers of Congress and the White House, would certainly call into question Republicans’ ability to govern.

But the latest version does differ from the previous in one crucial way: the current bill would, once again, allow insurers to penalize people with pre-existing conditions, thanks to an amendment proposed by Sen. Ted Cruz (R-TX) that would allow insurers to circumvent Obamacare rules to make their so-called “skinny plans” cheaper. Essentially, the amendment would allow insurers to operate as they did in the past, before Obamacare, when they decided the benefits and the people they would like to cover and the premiums they preferred to charge for those benefits.

Despite endless waffling by Republicans in the House and Senate, and repeated promises from Donald Trump himself to the contrary, the Cruz amendment would bring back the unfair and ruinous practice of charging people with chronic and critical medical problems higher premiums — a practice that the Affordable Care Act outlawed.

While Obamacare’s taxes on the rich would remain in place, health care companies would actually receive a major tax break under the Senate’s latest version of the bill.

While the Republican bill still offers subsidies, as the Affordable Care Act does, to help lower- and middle-income Americans offset the cost of private health plans, the Senate bill offers considerably less assistance. The GOP plan would also necessitate plans that offered less coverage, with much higher deductibles.

The predictable outcome of such legislation would be a split insurance market — one in which healthy Americans would enjoy newly “cheaper” bare-boned plans and could, for the time being, avoid the higher deductibles and out-of-pocket expenses while older, sicker and less wealthy Americans would have access to government regulated plans that covered pre-existing conditions and other “essential benefits” — but at an extremely high price. As a direct result, many Americans, as in the days before the ACA, would be unable to afford health insurance.

Under the Republican health care plan, low- to middle-income families, veterans, the chronically and terminally ill, the elderly, and the disabled, for example, would all have to put up or shut up.

Insurer groups, including the national Blue Cross Blue Shield Association of America and America’s Health Insurance Plans have warned that these “skinny plans” would, in fact, raise insurance premiums and destabilize the individual insurance market.

The American Hospital Association said the new version of the Senate bill kept the “unacceptable flaws” of the original version.

The new version does add $70 billion to the $112 billion in the original to help lower-income insurance holders cover out-of-pocket medical expenses and includes an additional $45 billion for opioid addiction treatment. Still, critics believe such changes meant to win over moderate Senate Republicans are not nearly enough to combat America’s opioid epidemic effectively, let alone to offset the massive cuts to Medicaid — America’s social safety net.

No matter how you look at it, millions of the most vulnerable Americans, especially elderly and sick people, will lose coverage under the GOP plan.

The Affordable Care Act expanded health insurance coverage to over 20 million people, largely through its Medicaid expansion program. Under the current version, that Medicaid program would be phased out, with $772 billion in cuts over the next 10 years. The current bill provides a mere $182 billion in “stability” funds to offset the damage.

According to The Washington Post, top Health and Human Services officials are using promises of additional monies from these funds to convince moderate Republicans to sign on to the bill, particularly those senators who have been publicly expressing their doubts.

“The ambiguous language… sets up a scenario in which the administration can dole out funding as its discretion, giving it leverage over states struggling to make ends meet, while on the flip side giving the Republican administration the opportunity to stiff blue states,” reports TPM.

On Thursday morning, McConnell met with a several moderates, including Sens. Shelley Moore Capito of West Virginia, Dean Heller of Nevada, Rob Portman of Ohio and Lisa Murkowski of Alaska hoping to win their support despite the lethal cuts to Medicaid that would directly harm a good number of their constituents.

Sens. Rand Paul (R-KY) and Susan Collins (R-ME) have already come out against the revised bill, albeit for entirely different reasons. Nevertheless, if Majority Leader McConnell loses just one more vote, the bill will not proceed to vote and will die on the Senate floor.

Essentially, the Senate Republicans’ repeal of Obamacare, like its counterpart in the House, massively cuts federal funding of health care insurance and replaces this guaranteed federal funding with relatively small block grants, awarded to states at the discretion of the Department of Health and Human Services. In the end, states will have to compete for what little money is available to make up for major losses in federal funding.

And Americans in every state, regardless of party or class, will suffer the consequences.

– Danielle Bizzarro

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