At this point, it's only a matter of degrees how misguided and cruel the proposals are by Republicans in Congress to "fix" America's health care system.
Still, the bill unveiled by Senate GOP leaders Thursday is even worse in some ways than the horrible bill the House narrowly approved in May.
The Senate's Better Care Reconciliation Act would eventually make deeper cuts to the Medicaid program for the poor. In California, Medi-Cal covers nearly 14 million, including half of the state's children and two-thirds of seniors in nursing homes.
By 2024, the bill would end Obamacare's federal money to expand Medicaid, which has allowed 4 million Californians to get insured. Unless the state steps in with substantially more funding - possibly $30 billion or more by 2027, compared to $24 billion under the House bill - many would lose coverage. And because California is a high-cost state, premiums and deductibles are likely to spike for some middle-class families.
So no matter the new name and a few tweaks, the bottom line of the Senate bill is the same: Millions of poorer people will lose their health insurance so that the richest Americans can get a huge tax cut they don't need. One-sixth of the U.S. economy will be upended, with unknown risks and consequences.
It's also outrageous that 13 senators - all white men - drafted this bill in secret for weeks. And now they're rushing to pass it next week before the July Fourth recess, before senators have to return home and face their constituents. And who knows what goodies for Big Pharma and other special interests may be hidden in the 142 pages.
Last week, President Donald Trump called the American Health Care Act approved by the House "mean" and urged the Senate to be more "generous." Thursday, he tweeted his support for the Senate bill.
The Senate bill does keep more of Obamacare's protections for people with pre-existing conditions. It would base tax credits to help people buy private insurance on income, as the Affordable Care Act does, rather than age, as the House bill does. But the subsidy would be smaller and fewer people would be eligible.
The Congressional Budget Office says that under the House bill, 23 million Americans would lose insurance by 2026 and Medicaid spending would be slashed by $834 billion over 10 years. Its analysis of the Senate bill is expected early next week, a day or two before the vote.
For all the objections and theatrics by Senate Democrats - Sen. Elizabeth Warren of Massachusetts called the tax cuts for the wealthy "blood money" - the bill's fate is out of their hands. Only 50 votes are needed to pass this bill in the Senate, and Republicans hold 52 seats.
Senate Majority Leader Mitch McConnell is trying to keep moderates and conservatives on board. Four conservative senators quickly announced their opposition to the current draft. If the bill fails on the Senate floor, it should not lead to an even more draconian version to win the votes of conservatives.
As we've said, Obamacare isn't perfect. But it has improved health care for many Americans. The right path is to fix its flaws and to focus on reducing health care costs, not to wipe it out.
If Republican leaders in Congress really meant what they said about unity and common purpose last week after the shooting of Rep. Steve Scalise, they'd slow down and craft a bipartisan plan with plenty of input from hospitals, doctors, patient groups and the general public.
That isn't likely to happen. Now it's about big money and partisan political power - and millions of poorer, sicker and older Americans are the collateral damage.
