The Way Trumpcare Is Being Changed That Actually Makes It Worse

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Due to the near-universal opposition to the Obamacare repeal bill, Republican leadership in the House of Representatives has agreed to modify the bill. But don't get your hopes up: Some ways Trumpcare is being changed actually make it much worse than it was before, in a big way.

Although the original Trumpcare bill was already bad news for poor Americans, many House conservatives thought it wasn't bad enough. The legislation scraps Obamacare's Medicaid expansion, which has provided health insurance to 11 million Americans, and yet it doesn't do so until 2020 — not soon enough for the Tea Party wing of the party. Additionally, the bill also fundamentally changes how Medicaid works, placing caps on how much federal money each enrollee is eligible to receive. However, some House Republicans felt that this was just another version of Obamacare.

The new Trumpcare addresses these concerns in two ways. First, rather than instituting a per capita cap, it switches Medicaid to a block grant, which is a much harsher restriction. Under a block grant system, each state would be given a lump sum from the federal government to fund its Medicaid program — regardless of how many people are enrolled or the health needs of the enrollees. This means that Medicaid would no longer provide guaranteed coverage to everybody who's eligible for it; instead, there would simply be a fixed sum of money for state officials to divide up in whatever manner they see fit.

Second, the bill would allow states to set a work requirement for Medicaid recipients. This is a lot more straightforward: In order to qualify for Medicaid, low-income Americans would need to meet some minimum threshold of employment. House Republicans are still working out the details of this.

House leadership agreed to these changes in order to satiate far-right Republicans, but while the tweaks will probably make it easier for the bill to pass the House, they may render it dead on arrival in the Senate.

This is because there's a gaping ideological gap between the most conservative House Republicans and the most liberal Senate Republicans. Both factions will have to support the bill in order for it to land on Trump's desk, and yet it's not clear that this is possible. Even before the recent tweaks, four Senate Republicans — which is more than enough to sink the bill — had objected to the limits Trumpcare places on Medicaid, arguing that they were too stringent. Well, guess what? The new version of the bill is even more stringent.

As Speaker of the House, Paul Ryan has one job here: Get the bill passed in the House. It's possible that he'll succeed in doing this— but in doing so, he may doom the chances of Trumpcare actually becoming law.