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Why it’s so hard for Senate Republicans to fix their health care bill, in one chart

There isn’t enough money to make up for the current plan’s cuts.

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

Mitch McConnell needs to spend more money if he’s going to pass a health care bill. The problem is he doesn’t have nearly enough funding available to make up for the current plan’s deep cuts to Medicaid and the financial assistance Americans receive to buy health insurance.

The Senate majority leader is working this week to come up with a plan that can get 50 of the 52 Senate Republicans to support it. One course for McConnell is keeping some of Obamacare’s taxes on the wealthy — something many Republican senators actually support — and using the money left over to soften the plan’s cuts to Medicaid and to the tax subsidies that Americans receive to buy private coverage.

But even if he made that change, it wouldn’t be nearly enough to make up for the existing cuts, according to the left-leaning Center on Budget and Policy Priorities.


As the CBPP chart makes clear, the current Senate bill cuts the financial aid and Medicaid by more than $1 trillion. Some dollars have already been claimed for the opioid crisis ($45 billion) and changes to health savings accounts, as the CBPP chart notes, further limiting the money that can be funneled toward Medicaid and the tax subsidies.

So even if McConnell keeps the biggest Obamacare tax on the wealthy, plus other funding that’s available to him, he would have only $250 billion to add to the bill.

It’s not at all clear that will be enough money to significantly offset the current projected coverage losses under the Senate bill: 22 million fewer Americans having health insurance in 2026, compared with under Obamacare. If McConnell can’t lower that number, he might not be able to persuade enough holdouts to come around and back the bill.

The takeaway is that the bill’s structure — ending the generous federal funding for Obamacare’s Medicaid expansion, capping Medicaid spending, and reducing financial aid for private coverage — might not be salvageable, even if you continue to tax wealthier Americans.

Sen. Susan Collins (R-ME), one of the moderate opponents who would be the target of any spending, told CNN she needed a “complete overhaul” of the bill before she would support it.

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