Shifting Dollars From Poor to Rich Is a Key Part of the Senate Health Bill – New York Times

Avik Roy, the president of the Foundation for Research on Equal Opportunity, and a conservative health care analyst, cheered the bill on Twitter, saying, “If it passes, it’ll be the greatest policy achievement by a G.O.P. Congress in my lifetime.” The bill, he explained in an email, provides a mechanism for poor Americans to move from Medicaid coverage into the private market, a goal he has long championed as a way of equalizing insurance coverage across income groups.

States would continue to receive extra funding for Obamacare’s expansion of Medicaid to more poor adults, but only temporarily. After several years, states wishing to cover that population would be expected to pay a much greater share of the bill, even as they adjust to leaner federal funding for other Medicaid beneficiaries — disabled children, nursing home residents — who are more vulnerable.

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Mitch McConnell, the Senate majority leader, in the Capitol on Thursday.

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Saul Loeb/Agence France-Presse — Getty Images

High-income earners would get substantial tax cuts on payroll and investment income. Subsidies for those low-income Americans who buy their own insurance would decline compared with current law. Low-income Americans who currently buy their own insurance would also lose federal help in paying their deductibles and co-payments.

The bill does offer insurance subsidies to poor Americans who live in states that don’t offer them Medicaid coverage, a group without good insurance options under Obamacare. But the high-deductible plans that would become the norm might continue to leave care out of their financial reach even if they do buy insurance.

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