During the first year of the Trump administration, the word “unprecedented” has been used so many times it has almost lost its meaning. But there simply is no other word to describe this presidency. First and foremost, there is the unprecedented degree to which the administration has attacked the country’s institutions in ways that threaten the foundations of our democracy. But this first year is also unique because of the unforgiving extent to which the Trump administration and the Republican-controlled Congress have leveled legislative assaults against poor people.
1. Attempts to Repeal the Affordable Care Act
Perhaps no issue is more indicative of this Congress’s hostility toward poor Americans than the slew of legislation introduced to dismantle the Affordable Care Act, or Obamacare. After the House’s passage of the American Health Care Act (AHCA), Senate Republicans took their own stab at dismantling the ACA, culminating in the Better Care Reconciliation Act (BCRA). Like their counterparts in the House, Senate Republicans suggested repealing the ACA’s taxes, restructuring its subsidies, eventually ending the Medicaid expansion and empowering states to opt out of some of the ACA’s mandated insurance features. BCRA tied the distribution of subsidies back to income, but in a reversal of the ACA, capped eligibility at 350 percent of the poverty line rather than 400 percent beginning in 2020.
To add insult to injury, subsidies would be much smaller—premiums for a mid-level plan for a 64-year-old who earned $26,500 a year could have skyrocketed by 2026 to $6,500. And that’s after the subsidies kicked in.
Between the lower subsidy limit and the less generous benchmark plan, poor Americans would have ended up paying more for lower quality insurance plans with premiums, deductibles and out-of-pocket costs so high they might have foregone a plan altogether. That’s especially true for patients with pre-existing conditions. Without mandates to cover “essential health benefits,” the BCRA, like the AHCA, empowered insurance companies to offer skimpy plans covering only the bare minimum, rendering them useless to those with serious health issues. Healthy Americans would have flocked to those plans, leaving sicker patients in segregated markets characterized by high-cost plans (but ones that actually meet their health needs). Thus, even as the Senate promised to protect people with pre-existing conditions, its plan would have propelled them into bankruptcy in order to keep their insurance coverage.
Projections from the Congressional Budget Office anticipated that the BCRA would result in adding 22 million people to the ranks of the uninsured.