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Full disclosure: I have not read the bill. So, any and all of this should be taken with a grain of salt. But I wanted to jump on the bandwagon and get my thoughts out. This is all off the top of my head, no particular order:

  • A LOT of this bill won't be able to get through reconciliation in the Senate because it doesn't affect the budget. So this bill will not become a law.

  • Beyond that, who knows the rules this will come to the floor with, but there will be amendments.

  • Most important: All of the tax cuts possible are in the plan. So we know by definition that fewer people will be covered. We just need to find out who.

  • Medicaid is the biggest group. Those in the expansion are gone (11 million) after a few years of transition. How many more will lose due to block granting? I haven't seen enough to know yet. But it seems that if you are middle-class and need nursing care, very few states will be able to afford that.

  • The subsidies look a lot more like Obamacare now. They are more related to income, not just age. However, they don't take into account prices in an enrollee's location. So people in states where insurance is expensive, in what used to be in the Medicaid gap will not be able to get coverage.

  • If you are lucky and live in a state where insurance is fairly inexpensive, the subsidies might be close to enough to cover a plan.

  • Mandate is gone. Continuous Coverage is in. Insurance companies MUST charge you 30% more if you didn't come from cont. cov. How is this legal? The government can tell private companies what to charge now?

  • In places where the subsidies aren't high enough, people will go without insurance until they need it and then find a way to pay the penalty. This does not look like a stable system. So smells like death spiral anywhere.

  • Not clear what happens on minimum essential benefits.

  • With taxes gone, Medicare Trust Fund exhausted by 2024.

  • "Cadillac Tax" is still there, but delayed until 2025.

  • No score from the CBO as to either coverage or cost. With taxes gone and subsidies still there, I don't think it is close to deficit neutral. But they might have taken enough from Medicaid to cover it, hard to say.

  • If the last clause there is correct - then this literally is taking Medicaid / Subsidies from those @ 200% of the federal poverty line and below and using it to give tax cuts to the top 1%.

OK, sorry for disjointed stream of consciousness. And I'm sure I'll have corrections by tomorrow as more comes out. And I need to read this whole thing now...

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