Since Senate Republicans released their healthcare reform bill early Thursday, the narrative from the media has been that this bill is a giant tax cut for “the rich.”

This narrative is false. ObamaCare imposed a long list of taxes that directly hit middle class families.

The Senate’s “Better Care Reconciliation Act” (BCRA) repeals these taxes and contains a total of $701 billion in tax reductions over the next decade.

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Experts don’t always agree, but eight of us (including Grace-Marie Turner) from right and left found common ground on key health reform recommendations.  We agreed that states should be given greater authority to configure and redirect revenue streams from Medicaid, CHIP and private insurance; that the existing tax exclusion for employer-sponsored health benefits should have reasonable limits; and that states need new authority to simplify their insurance markets and develop fiscally sound and affordable coverage options for their most vulnerable citizens, providing more help to those who can least afford the premiums.

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The Congressional Budget Office says 15 million people will lose medical coverage next year if the Senate GOP’s health-care bill becomes law. That’s not quite accurate. CBO doesn’t believe that millions will “lose” their insurance in 2018. Instead, the agency thinks that millions will happily cancel their coverage—even those who get it for free. The reason: The Senate bill would repeal the Obamacare tax penalty on the uninsured, known as the individual mandate. If CBO is to be believed, 15 million people didn’t want health coverage in the first place. They enrolled only to keep the IRS off their backs.

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On Monday the Congressional Budget Office released its cost estimate of the Republican Senate Better Care Reconciliation Act.  CBO calculated that the proposed bill would reduce the deficit by $321 billion over the next decade. That is welcome news.

Less welcome, however, was CBO’s conclusion that the Senate bill would result in an additional 15 million uninsured in 2018 due to a lack of penalties. By 2026, CBO reports 22 million more Americans would be uninsured, primarily due to lower Medicaid coverage.

No matter that the number of Americans on the Obamacare exchanges is shrinking due to higher prices and fewer companies offering coverage.

Dave Hoppe, former chief of staff to House Speaker Paul Ryan, asked me in an email, “If there are few insurance companies offering insurance through the exchanges in 10 years, how are people without insurance losing anything?”

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The Senate Republican health-care bill would not repeal and replace Obamacare. The federal government would remain the chief regulator of health insurance. No state would be allowed to experiment with different models for protecting people with pre-existing conditions. Federal policy would continue to push people away from inexpensive catastrophic coverage. The bill also seems unlikely to stabilize insurance markets, even though their current instability is one of the main Republican talking points for passing it. The legislation gets rid of the “individual mandate” — Obamacare’s fines for not buying insurance — but keeps the regulations that made the mandate necessary. The result is likely to be that healthy people leave the market and sick people face much higher premiums.

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The Senate health-care legislative draft — officially titled the Better Care Reconciliation Act of 2017 — will, if passed, represent the greatest policy achievement by a Republican Congress in generations.

For decades, free-market health-reform advocates have argued that the single best idea for improving U.S. health care is to maximize the number of Americans who can afford to buy health insurance for themselves, instead of having to depend on the government or their employer. The Senate bill transforms the American health insurance landscape in this direction.

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The Senate proposal wouldn’t cut Medicaid spending in real dollars — spending would continue to grow — but it would slow the rate of spending for the program, phase out extra money the federal government has given to states that expanded Medicaid under the Affordable Care Act (also known as Obamacare) and leave states to pick up more of the tab.

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If we want to make headway on improving public policy discourse, a good place to start might be with how we’re debating Medicaid policy, in particular how it might be affected by pending legislation to repeal and replace the Affordable Care Act (ACA), including legislation presented on Thursday by Senate Republicans.

Medicaid has long been on an unsustainable cost growth trajectory. This was true long before the ACA was passed in 2010, though the ACA exacerbated the problem. Annual federal Medicaid spending is currently projected to grow from $389 billion in 2017 to $650 billion in 2027. The biggest problem with that growth rate is that it’s faster than what’s projected for our economy as a whole. As with Social Security and Medicare, Medicaid costs are growing faster than our ability to finance them.

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The Senate bill is the product of a decision not to repeal Obamacare but to improve things where possible—moving incrementally in the direction of a more functional and more market-oriented system—within the framework Obamacare established.

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The House bill contained a fatal flaw. Its flat tax credits would price millions of near-elderly low-income workers out of the insurance market and trap millions more in poverty. Fortunately, buried in the House bill was a way out. Section 202 of the bill contains a transitional schedule of tax credits that was meant to serve as a bridge between the old Obamacare system and the new Paul Ryan system. If you simply kept that bridge in force, and got rid of the flat tax credit, you’d solve the problem with the House bill. By making that change, the near-elderly working poor would be able to afford coverage, and the poverty trap would be eliminated. And that’s precisely what the Senate bill did! Section 102 of the Senate bill—the Better Care Reconciliation Act of 2017—closely mirrors Section 202 of the House bill, with age- and means-tested tax credits up to 350% of the Federal Poverty Level.

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