President Donald Trump’s bill is big but far from beautiful

Carl P. Leubsdorf, Tribune News Service

No one disputes that President Donald Trump’s “One Big Beautiful Bill” is big – hundreds of pages of significant tax and spending measures. But it’s far from beautiful. Indeed, it will cause untold damage to the nation’s economy and health system, reverse recent efforts to encourage alternative energy sources, widen the gap between the wealthiest and poorest citizens, and increase the federal deficit. Polls show it is increasingly unpopular with the public, prompting North Carolina Republican Sen. Thom Tillis to warn GOP colleagues it will likely prove a political albatross in next year’s elections that could cost them control of Congress.

Trump and his GOP allies have ignored such criticism in touting the bill, noting it would extend the 2017 tax cuts, reduce taxes on tipped income and add billions for immigration enforcement and defense. Without action, they warn, many Americans would face big tax hikes, though, in fact, there is time to prevent that in a separate, less costly bill. The administration also claims, unconvincingly, that a combination of the tax cuts and the benefits from the president’s controversial increase in import tariffs will spur economic growth and reduce the deficit.

But the nonpartisan Congressional Budget Office and other independent analysts note that past Republican tax cuts failed to provide predicted growth and predict that, instead, the bill will increase the deficit by several trillion dollars.

At the same time, it would cut Medicaid, Obamacare and other benefit programs by more than $1 billion, costing millions their health insurance and weakening the nation’s health systems, especially in rural areas that have been the nation’s strongest Trump supporters.

Conservative critics in both houses blamed insufficient cuts in those programs for the measure’s anticipated $3 trillion increase in future deficits and likely hikes in interest rates. But independent analysts said the real cause is extending and augmenting Trump’s 2017 tax cuts. Administration officials also argue that the bill won’t cost individuals their Medicaid or Obamacare benefits. “No one will lose coverage as a result of this bill,” Budget Director Russell Vought said on CNN.

It’s true the bill doesn’t directly reduce per-person Medicaid payments. But its proposed work requirements and changes in enrollment procedures and eligibility will cost millions of poor families, CBO and other analysts say.

And that’s not only the case with Medicaid, it’s also true for other federal benefit programs — the Affordable Care Act, the Supplemental Nutrition Assistance Program and the child tax credit.

Some senators were especially concerned that the Medicaid cuts would force the closing of rural health centers. Missouri Sen. Josh Hawley – normally a Trump conservative – called the cuts “both morally wrong and politically suicidal.” But that didn’t stop him from joining his GOP colleagues in voting for those cuts, after Senate Republicans added a $25 billion fund to bolster rural hospitals.

Overall, it cuts Medicaid costs by nearly $1 trillion, mostly by requiring states to implement new work requirements and change enrollment and eligibility procedures. The CBO and other analysts say the complexity of those rules changes and the prospect that states might make offsetting reductions could cost more than 8 million people their benefits without increasing the number of Medicaid recipients with jobs.

Such dire forecasts are bolstered by the experience of states like Arkansas and Georgia, which discovered that work requirements reduced participation because so many poor and elderly people found them too onerous to meet. Another provision would complicate the enrollment process for more than one million disabled Medicare beneficiaries who get Medicaid help, according to The Bulwark’s Jonathan Cohn, a leading health care analyst.

As for the Affordable Care Act, analysts say 16 million Americans would either lose their Obamacare health insurance or become uninsured because of more than $300 billion in cost-cutting provisions and the expiration of Biden-era subsidies that helped many pay.

In addition, estimates are that at least two million children would lose their access to the SNAP program. And though the bill would increase the annual child tax credit, poor families with a total of 20 million children may be blocked from getting it by added requirements like parents needing a Social Security number.

Then, there’s the anticipated fallout from these cuts.

Until now, their trickle-down benefits – especially the expansion of state-run Medicaid programs through the Affordable Care Act — have bolstered rural health systems and kept financially struggling rural hospitals in business.

“Cuts to Medicaid . . . force decisions about whether we can keep our maternity ward open, retain emergency services, or offer mental health care,” Todd Patterson, CEO of Washington County (Iowa) Hospitals and Clinics, said in a letter to The Des Moines Register.

And that was before the Senate Finance Committee made the anticipated impact worse by changing how states handle Medicaid reimbursements – and expanding proposed work requirements.

The health provisions are not the only damaging ones. Besides ending subsidies for electric vehicles and speeding the phase-out of subsidies for wind and solar projects, a Senate addition would tax projects that can’t prove they didn’t use Chinese components. Another offers a new tax break for coal production. Recent polls showed the bill’s main support comes from Trump’s Republican supporters. Everyone else – including Republicans not aligned with the president – opposed it.

The White House says Trump and other top officials will hit the road after enactment to tout its benefits. But Democrats are gearing up too, and they may have the better argument.