First and foremost, nothing has happened. There are no changes to the Affordable Care Act. Yet. There is no new law yet. Not until the Senate passes their own bill, and the president signs something.

But SOMETHING WILL HAPPEN. Just not yet. The House has adopted a new bill, by 2 votes – including a “yes” vote by every single California Republican– nd the Senate will adopt its own version. The only thing we know for sure is that the Senate version will be different from the House version because the Senate and the House always differ on any major legislation.

With that in mind, what is the big picture on what the House just passed? We look at the “big picture” because the details of this new “American Health Care Act” (notice it does not include in its title any promises, unlike Obamacare, which included “patient protection” and “affordable” in its full title; this one just says its about “health care”) are as complex, ambiguous, confusing, as the Affordable Care Act.

So, back to the “big picture” –

1. It abolishes the “individual mandate” by killing the fees/fines/taxes that had to be paid for not having health care insurance. No one is required to have health care insurance.
2. It abolishes the “employer mandate” the same way. No employer has to pay for health care insurance for any employee.
3. The Exchanges/Marketplaces are still in place for individual purchasers, but premiums in them will go up, probably quite substantially, because tax credits and subsidies to help reduce premiums are to be substantially reduced.
4. Medicaid will be slowly slaughtered. For the 11 million or so individuals who were added to its rolls by the ACA, coverage will be harder to maintain and will disappear over time. New rules will drop them from Medicaid if they are not qualified for any two month period, and by 2020, no new individual enrollees will be allowed, and States will get flat amount “block grants” so that Medicaid will no longer pay for all care necessary but just for a fixed amount.
5. Finally, states will be able to get waivers that will be almost automatic so they can change and/or reduce the ten essential health benefits (EHBs) which must be part of any health insurance policy/program right now, and they will also be able to get waivers to bail out of other parts of the ACA.
6. Sorry, but people with “pre-existing conditions” (nearly all of us sooner or later) will find it harder to get insurance, to maintain insurance, and to pay for insurance.

Overall, what does this mean for union health care trust funds, and for large public health plans?

1. The cost of health care will go up for all of us. Less Medicaid money, lower tax credits and subsidies in the Exchanges, millions losing their insurance – someone has to pay for health care for the uninsured when they show up at emergency rooms, sicker than ever. Who? Those of us who have insurance will go back to seeing premiums go up more rapidly than for the last 5 years. Just like before the ACA.
2. The benefits we can afford will probably be cut as premiums go up, to keep it all somewhat affordable.
3. The deductibles will go up as benefits go down.
4. But – we will survive, our benefits will survive, and we will continue the battle for better, less expensive health care for ALL.

Yes, the House version of Trumpcare is bad news for all workers, including the millions who voted for him and are now being sold out. Even though there will be lots of noise about how great this is, we all know this is just more of The Big Lie. It’s no mistake that everyone associated with health care – doctors, hospital chains, insurers, everyone else – says the House bill is awful, a real blow to good health care for all.

What’s next? The Senate has to come up with something as soon as possible – health care systems only have until June 21st to decide whether to participate in the Exchanges in 2018 – and they won’t decide until they know how many potholes there are in the playing field.

Members of Congress who passed the Obamacare repeal talked a good line about cutting taxes, but that was just for the rich. They kept the biggest tax of all on working people– someone has to pay for this disaster

After all is said and done, the House bill can be reduced to this: a huge tax cut, perhaps 500 billion dollars over then years, for the super-rich, paid for by all of us, paying more for our healthcare.

If taxes on the super-rich don’t pay for health care, and they do not under this new bill, then we do.