In this March 23, 2010, file photo, President Barack Obama signs the Affordable Care Act in the East Room of the White House. Obama criticized the Senate Republicans’ plan to replace that law, known as Obamacare, saying the Senate bill gives rich people a tax break by reducing health care for others. (AP Photo/J. Scott Applewhite, File)
Photo: J. Scott Applewhite
Photo: J. Scott Applewhite

Obama’s assessment of Senate health bill mostly on target

Former President Barack Obama recently took to Facebook to blast the Senate health care bill that would dismantle much of the Affordable Care Act, his signature legislative achievement.

We looked into his claim about the budgetary effects of the Senate Republican plan that repeals or reworks much of the ACA, known as Obamacare.

Obama is right that the Senate bill contains a tax cut for wealthy Americans and medical-related businesses. The amount will likely be in the same ballpark as the House bill, which cut taxes by about $1 trillion over 10 years, with high-income households and the health care industry gaining most of those benefits, according to the Tax Policy Center.

The Senate bill repeals Affordable Care Act taxes that levy a 3.8 percent fee on investment income, as well as a tax on individuals making $200,000 or more ($250,000 for couples).

The bill also eliminates ACA taxes that target health insurers, and makers of prescription drugs and medical devices.

We should also note that middle- and lower-income consumers would likely see benefits from tax cuts in the form of lower prices and reduced fees on health savings accounts, as we pointed out in an earlier check of a House version of the bill.

Obama is correct that tax cuts would be offset by cutting spending on health care. But it’s a stretch to say everybody’s health care would suffer, when what’s on the chopping block is federal funding for lower-income Americans.

In the individual market, the Senate bill changes the formula for calculating how much help the federal government gives lower-income Americans to buy insurance.

Compared with the Obamacare formula, the Senate GOP version would amount to a 15 percent across-the-board cut in premium subsidies and result in low-income people paying higher premiums for bigger deductibles, according to Larry Levitt, senior vice president of the Kaiser Family Foundation, a nonpartisan health care think tank.

Starting in 2020, the Senate bill also repeals Obamacare’s cost-sharing subsidies that help lower-income Americans defray the cost of deductibles and out-of-pocket expenses.

But the biggest cut in federal spending comes out of Medicaid, by changing the share carried by the federal government, relative to states.

The Senate bill converts federal Medicaid funding to a per capita cap starting in 2020, placing a ceiling on the funding a state gets per enrollee. Alternatively, states could opt for a block grant, a fixed amount of federal funds. Under either approach, the federal government would provide less to states than it does under Obamacare.

Separately, starting in 2021, the Senate bill begins a three-year phase-out of enhanced funding given to the 31 states (plus Washington, D.C.) that expanded Medicaid under Obamacare. As we noted in a previous check of the House bill, reducing this funding would likely cause states to end expansion.

Our ruling

The Senate bill does give a tax cut to wealthy Americans and medical-related industry.

It’s a bit hyperbolic to say everybody’s health care would be cut to finance the tax cut; it’s mostly lower-income people who lose out as a direct result of the bill. Obama is right that the Senate bill would deliver a tax cut as it reduces the federal funding lower-income Americans would get to help buy insurance. The bill would also repeal funding to defray deductibles and out-of-pocket costs for those eligible. It also lessens the share of Medicaid funding carried by the federal government, relative to states.

We rate Obama’s statement Mostly True.

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