The U.S. Senate was supposed to release its long-awaited healthcare bill today after a secretive process that left most Republican senators and every Democrat in the dark. Senate leaders had promised that their bill would be a complete rewrite of the one that passed the House in May. But instead of a bill, the Senate released a “discussion draft” of a measure that aims to revamp one-sixth of the U.S. economy and could be voted on as early as next Thursday. The New York Times reports that the discussion draft looks a lot like the House bill that would strip health coverage from 23 million Americans while cutting taxes on the wealthy.

The bill would create a new system of federal tax credits to help people buy health insurance, while offering states the ability to drop many of the benefits required by the Affordable Care Act, like maternity care, emergency services and mental health treatment. The Senate bill — once promised as a top-to-bottom revamp of the health bill passed by the House last month — instead maintains its structure, with modest adjustments. The Senate version is, in some respects, more moderate than the House bill, offering more financial assistance to some lower-income people to help them defray the rapidly rising cost of private health insurance. But the Senate measure, like the House bill, would phase out the extra money that the federal government has provided to states as an incentive to expand eligibility for Medicaid. And like the House measure, it would put the entire Medicaid program on a budget, ending the open-ended entitlement that now exists.

The healthcare bill is opposed by doctors, nurses, hospitals, and virtually every major patient advocacy group. Now the insurance industry is getting involved. A group of industry executives wrote a letter to Senate leaders explaining that the Medicaid caps at the heart of the bill are simply bad policy:

While this may appear positive from an immediate budgetary perspective, these amounts spell deep cuts, not state flexibilities, in Medicaid. There are no hidden efficiencies that states can use to address gaps of this magnitude without harming beneficiare or imposing undue burden to our health care system and all U.S. taxpayers. Reducing the federal government’s share of Medicaid in this manner is not meaningful reform to bend the cost curve. It is simply an enormous cost shift to the states. It does nothing to address underlying drivers of cost of care, like expensive new drugs and therapies, and an aging population living longer with disability. States are already hard-pressed to meet these challenges while balancing their budgets.

Opioid addiction & the AHCA

Prescription drug dependency is a growing problem in Louisiana, and it is affecting businesses and employers across the state, report the staff of the Greater Baton Rouge Business Report. High turnover rates, absenteeism, and decreased productivity are driving up business costs and leaders in the business community are calling for action:

The impact on workers and employers is “quite literally an epidemic,” says Jim Patterson, Louisiana Association of Business and Industry vice president of government affairs. He adds the issue has been known and talked about among the business community, but not broadly enough. “It’s kind of a dirty little secret in the workplace,” Patterson says. “We are overdue in trying to address the problem of the overprescription of opioids.” In recent years, Louisiana has seen an alarming rise in opioid-related overdoses: It is one of just eight states with more opioid prescriptions than residents.

Providing treatment and therapy to those who are addicted to opioids would become a lot harder if the American Health Care Act becomes law. As a group of 10 reporters for the Associated Press point out, Medicaid expansion has been a critical source of funding for helping the many working-age adults who are dealing with addiction:

Medicaid cutbacks would hit hard in states deeply affected by the addiction crisis and struggling to turn the corner, according to state data and concerned lawmakers in both parties. The central issue is that the House health care bill would phase out “Obamacare’s” expanded Medicaid, which allows states to provide federally backed insurance to low-income adults previously not eligible. Many people in that demographic are in their 20s and 30s and dealing with opioid addiction. Dollars from Washington have allowed states to boost their response to the crisis, paying for medication, counseling, therapy and other services.

A handful of Republican senators have proposed adding to the AHCA a lump sum of grant funding dedicated to drug treatment, to replace the services lost due to the elimination of Medicaid expansion. That funding would not be an adequate replacement, advocates argue, because it would not be able to be used to provide the many other medical services that people struggling with addiction often need. Erin Mershon with Stat News reports:

“Sure, yeah, you know, it sounds wonderful. Here’s billions of dollars to help combat this issue. But the issue is larger than that,” said Mark Drennan, the executive director of the West Virginia Behavioral Healthcare Providers Association. Individuals with an opioid addiction are much more likely than the general population to suffer from hepatitis C, post-traumatic stress disorder, and anxiety, among other conditions. Even if additional funding made treatment services available, it wouldn’t help those struggling with addiction address those other medical issues.

A plea to HUD

Prompted by new enforcement actions by the U.S. Department of Housing and Urban Development (HUD) in 2015, stakeholders in New Orleans took a long look at the issue of housing segregation in the city. Per HUD’s requirements, they developed a report with a list of recommendations aimed at reducing racial segregation in housing. Making some of those recommendations a reality depend on continued support and enforcement from HUD, which may not come through under the new administration, according to Cashauna Hill, Director of the Greater New Orleans Fair Housing Action Center:

HUD Secretary Ben Carson has warned against making subsidized housing too “comfortable.”  He has long been skeptical of fair housing policies, once referring to them as a potentially harmful “social engineering scheme.” This skepticism runs counter to masses of evidence. For instance, a report from the Urban Institute found that housing segregation has substantial economic costs. The study found that ending segregation in Chicago would increase black income per capita by 12.4 percent and that 83,000 more adults would complete college.  Nevertheless, potential cuts to HUD’s budget in 2018 would threaten enforcement of the work that ends segregation.

Dream hoarders

The top 1 percent of income earners are often looked at as the ones who are hoarding wealth and privilege at the expense of the rest of the 99 percent. A new book by Richard Reeves of The Brookings Institution, however, suggests that if we truly want to even the playing field and decrease economic inequality, we must acknowledge and address the behavior and policies supported by the wealthiest 20 percent of households. The Atlantic’s Annie Lowery:

They support policies and practices that protect their economic position and prevent poorer kids from climbing the income ladder: legacy admissions, the preferential tax treatment of investment income, 529 college savings plans, exclusionary zoning, occupational licensing, and restrictions on the immigration of white-collar professionals.   As a result, America is becoming a class-based society, more like fin-de-siècle England than most would care to admit, Reeves argues. Higher income kids stay up at the sticky top of the income distribution. Lower income kids stay down at the bottom. The one percent have well and truly trounced the 99 percent, but the 20 percent have done their part to immiserate the 80 percent, as well—an arguably more relevant but less recognized class distinction.

Number of the Day

$221 billion –  Estimated cost of services for low-income individuals who will seek treatment of opioid addiction between 2018 and 2026. That is $176 billion more than the $45 billion fund senators have suggested adding to the AHCA to pay for opioid addiction treatment during the same time period.  (Source: The Center for American Progress)