Following a series of middle-of-the-night backroom deals, and less than an hour after the final language was unveiled, Senate Republicans voted to pass a bill that would raise food and health care costs on families, increase poverty and hunger, and take health coverage away from millions of people while doubling down on costly tax cuts for the wealthy and corporations.
The Senate Republican bill’s federal Medicaid cuts are even deeper than the massive House cuts, making it more likely that states would cut their programs and putting rural hospitals and other community health providers at even greater long-term risk of closure.
House Republicans, many of whom looked to the Senate to craft a bill that was less damaging than the House bill, must stand up for their communities and reject it.
The more people have learned about the bill, the more opposition has grown. Now we will learn whether House Republicans, with time to reflect on the damage this agenda would cause and the ways the Senate made the bill worse, are as thoughtful as the people they serve.
Just days ago, some House Republicans expressed opposition to the additional Medicaid cuts the Senate was considering. Those additional cuts are in the Senate Republican bill that the House is expected to vote on as soon as tomorrow.
The Senate Republican bill would cut Medicaid by nearly $1 trillion, compared to $800 billion in the House Republican bill. The deeper cuts translate into larger harmful impacts.
The bill also would expand the House Republican bill’s provision that takes Medicaid coverage away from people who don’t meet a red-tape-laden work requirement by applying it to parents enrolled through the Medicaid expansion who have children older than 13.
Working parents who get tripped up by red tape, parents who get laid off and are looking for work, parents who lose their jobs when they get sick or need to care for a sick child — as well as adults without children who have disabilities, are between jobs, or are working — would lose access to the health care they need to work, to care for their children, and to beat treatable illnesses.
Relative to the House Republican bill, the Senate version would make it even harder for some states to finance their Medicaid programs. Senate Republicans know the bill would hurt rural hospitals — that’s why they added a face-saving temporary fund, but it won’t rescue rural providers when the funding runs dry and the permanent cuts to Medicaid and Affordable Care Act (ACA) marketplace coverage remain. This is particularly true because the revised Senate fund gives the Health and Human Services secretary significant discretion in how the funds would be allocated. Rural providers need people in their communities to have health coverage they can count on. Without that, more rural hospitals will close and more people with and without coverage will be cut off from care they need.
The Senate Republican bill also would take health coverage away from even more immigrants living and working in the U.S. lawfully than the House bill would. The Senate bill would take away federal funding of Medicaid and Children’s Health Insurance Program coverage for refugees, people granted asylum, certain victims of sex or labor trafficking, and certain victims of domestic violence, among others. This ban includes children, and as in the House bill, it also would take away Medicare, ACA premium tax credits, and food assistance through SNAP from these groups. Despite countless misleading statements, immigrants in the country without a documented status are already ineligible for all of these programs; everyone who would lose health coverage and food assistance because of this bill is living lawfully in the U.S. (One anti-immigrant health provision in the House bill was not included due to a parliamentarian ruling.)
The Senate Republican bill would also raise families’ grocery costs, taking food assistance away from millions of people, including children and veterans, and forcing unaffordable costs on states. When states can’t pay those costs, they would be left with two choices — take SNAP benefits away from large numbers of people or end their SNAP programs entirely.
Again, it is clear that at least some Senate Republicans understand how damaging the provision is — they created a preposterous carve out to delay implementation of the cost-shift for states with the highest error rates in the country as a way to secure the votes they needed. But delaying for a handful of states a harmful provision that could unravel our most important anti-hunger program as a national program would not undo its damage.
Even as the Senate Republican bill would make deeper health care cuts, it continues the House’s approach of large tax cuts for the wealthy, including raising the amount heirs can inherit tax free from the largest estates to $30 million per couple and extending a deduction for business owners that would deliver more than half its benefits to millionaires.
The Senate bill would cost about $3.3 trillion when you remove the gimmick of assuming it is free to extend tax cuts. That is basically the same cost as extending all of the 2017 tax law’s expiring tax cuts for families — including millionaires — without any cuts to Medicaid and SNAP.
House Republicans should step back and find the courage to say no to any bill that would raise costs and take health coverage and food assistance away from people struggling to afford the basics — all while making deficits and debt soar and exposing our economy to more long-term risk.
But at the very least, as House Republican leaders seek to jam the Senate bill through the House, concerned House Republicans should follow through on their promise not to support a final bill that threatens access to Medicaid coverage and reject it.
If they don’t, they, along with their Senate counterparts, will own its impacts. Unfortunately, it is their constituents who will pay the price for their poor leadership.
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