The CBO chart that shows the Senate health care bill is really about tax cuts

It’s hard to miss the fundamental design of the Senate’s health care plan to repeal and replace Obamacare: a bill that makes deep cuts to services for low-income Americans to pay for tax cuts that would largely benefit the country’s wealthiest.

The Congressional Budget Office’s report now confirms it: Medicaid, a health service for poorer Americans, as well as the disabled and elderly, would see a $772 billion cut over the next 10 years.

To what end? This chart in the CBO’s report is a telling diagram of why Republicans are trying so adamantly to gut the program: They’re trying to offset the cost of tax cuts to reduce the deficit. Here is the chart:

As you can see, on one side there are the parts of the health care bill that would increase the deficit, the majority of which come from the “repeal or delay of taxes on high income people, fees on manufacturers and excise taxes enacted under AHCA” — in other words, cutting taxes on the rich and corporations.

Then in the “savings column,” there is $772 billion from a “reduction and termination of enhanced federal matching funds” and “per capita-based cap on Medicaid payments.” This is in reference to the part of the health care bill that looks to phase out Medicaid expansion in 2021 and restructure funding for the program that would ultimately result in less funding to states for Medicaid.

Vox’s Sarah Kliff explained this major change in the programs:

This bill would convert Medicaid to a “per capita cap” system, where states would get a lump sum from the federal government for each enrollee. Or states would have the opportunity of a block grant — a sum of money untethered from the number of people involved.

This is very different from current Medicaid funding. Right now the federal government has an open-ended commitment to paying all of a Medicaid enrollee’s bills, regardless of how high they go.

The Senate bill would set different amounts for different groups of people. It envisions, for example, likely higher payments to cover Medicaid enrollees who are disabled (and tend to have higher costs) than Medicaid enrollees who are kids (generally healthy with lower costs).

The CBO is laying out clearly: The Better Care Reconciliation Act of 2017 reduces the deficit overall by $321 billion over the next 10 years — a major goal of conservatives — but does so on the backs of the most vulnerable Americans in exchange for tax cuts.

As Vox’s Andrew Prokop put it, there’s no hiding it: “It’s a massive redistribution from the poor to the rich.”