GOP tax bill is just another way to repeal health care. Will coverage ever be safe?
The proposed tax bill from the Republican party still includes the healthcare repeals that were unsuccessfully pushed in the Senate two months ago. The GOP priority to repeal and replace Obamacare seems to have driven the tax bill, which appears to still cover the main points of the prior agenda: reduce the funding for health care for low-income citizens, seniors and children; use this funding to lower taxes for higher-income citizens; and end any federal protections against discrimination towards those with pre-existing conditions. The bill appears to benefit corporations and wealthy citizens, offering significant permanent tax cuts. By 2025, the bill - if passed - will give tax cuts of an average $360,000 to the top 0.1 percent of American homes. These tax cuts will be funded by reductions in health care benefits across private coverage, Medicare and Medicaid. A key point is the predicted $338 billion cut to assistance for working-class Americans' insurance, with the requirement for citizens to purchase care up for removal. The non-partisan Congressional Budget Office has predicted that all citizens' insurance will cost 10 percent more if the bill passes. The American Academy of Actuaries, an independent body, warns of  “severe market disruption and loss of coverage” if insurers no longer offer coverage. In addition to this, those with severe chronic conditions, nursing home care requirements or high-cost medication needs will no longer be able to deduct medical expenses. The presidential decree that allows insurance companies to exploit loopholes to exclude those with pre-existing conditions also compounds the issue. The tax bill will be enabled by a budget that gives 10 years for debt growth of up to $1.5 trillion with only 50 votes in the Senate. The debt will likely be used to facilitate cuts to the Medicaid and Medicare programs. , Medicare is already facing cuts of $250 billion over 10 years.

Andy Slavitt

Opinion columnist

It has been just two months since the Senate gave up on trying to pass a series of health care bills that Americans had soundly rejected in poll after poll. Yet the same Republican recipe for health care now is back on the table in the form of the lopsided tax bill that the Senate plans to vote on this week.

A lot of people get intimidated by the idea of trying to understand the tax bill. It’s a shame because, much like congressional budgets, tax bills reveal priorities.

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And GOP priorities are easy to follow as they haven’t changed since the party failed to accomplish its three-part health care agenda: Cut the money going toward health care for low-income people, seniors and kids; use that money to cut taxes for people in the upper-income brackets; and end the federal protections that stopped discrimination against people with pre-existing conditions. Flip the order, and the tax bill looks the same.

Much like the earlier health bills, with their corporate tax breaks and breaks for the upper-income brackets, the dollars and cents of the House and Senate tax bills point to clear beneficiaries and losers. The beneficiaries? Corporations and wealthy individuals (particularly those who stand to inherit large estates), who get large permanent tax cuts. In 2025, the bill would give tax cuts averaging $360,000 to the top 0.1% of households.

And like the health care bills last summer, these tax cuts are paid for in large part with cuts to health care benefits — affecting people with private coverage, Medicare and Medicaid.

To start, an estimated $338 billion that is helping millions of working-class Americans pay for insurance is on the block to be cut. Republicans argue that these are people who are being compelled to buy health insurance and so neither they nor anyone else will be hurt. That’s simply untrue.

Yes, there is a requirement that Americans purchase health care or pay a penalty, and the Senate GOP proposes to remove it. And requiring people to do something is not wildly popular. But why does that requirement exist? Former Massachusetts governor and 2012 Republican presidential nominee Mitt Romney put it this way in 2011: “It is fundamentally a conservative principle to insist that people take personal responsibility as opposed to turning to government for giving out free care.”

It’s also a good basic insurance principle — more people with insurance reduces everyone’s costs. The non-partisan Congressional Budget Office expects everyone’s insurance to cost 10% more if the Senate GOP is successful.

The American Academy of Actuaries, an independent and just-the-facts body, says it's even worse than that. It predicts “severe market disruption and loss of coverage” as insurers stop offering coverage.

That’s not all. In the version of the tax bill passed this month by the House, Americans who have serious chronic conditions or pay for nursing home care or high-cost medications would lose the ability to deduct medical expenses. These are people with often crippling medical bills, nearly half with annual incomes under $50,000 and more than half of them 65 and older.

This assault on the sick fits with the executive order the president signed last month, which is designed to give insurance companies loopholes so they can exclude people with pre-existing conditions, adding an effective surcharge to policies that do cover people with pre-existing conditions.

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To pave the way for this tax bill, Republicans passed a budget that over 10 years allows them to grow the debt by up to $1.5 trillion with just 50 votes in the Senate. And so far, most of the party's deficit hawks are suspiciously silent. There is a half-hearted set of GOP talking points claiming the economy will grow enough to offset those lost taxes, but 37 out of 38 economists recently surveyed disagreed.

More likely, the $1.5 trillion budget hole will be used to meet the objectives of the failed health care repeal bills — to make dramatic cuts to the Medicaid and Medicare programs. Conveniently forgetting it was their tax cuts for the wealthy that got us there, these same lawmakers will decry the manufactured fiscal crisis and bemoan that we can’t afford the cost of health care for our older and sicker citizens.

Many of these cuts will occur automatically. Under a 2010 pay-as-you-go law, Medicare will automatically face draconian cuts of $250 billion over 10 years. And three former Defense secretaries warned that the tax bill would endanger national security funding, which should make John McCain, chairman of the Senate Armed Services Committee, think twice before signing on.

Tax cuts for the wealthy? Health care repeal? Call it what you will. For this Congress and White House, they are two sides of the same coin — gold on one side, lead on the other.

Andy Slavitt, a member of USA TODAY's Board of Contributors, is a former health care industry executive who ran the Affordable Care Act and the Centers for Medicare and Medicaid Services from 2015 to 2017. Follow him on Twitter: @ASlavitt