- Paul Rosenberg
By Paul Rosenberg, Senior Editor
“When you look at the Republican bill it should not be seen as a healthcare bill, because throwing millions of people off of health care is not health care legislation. What it should be seen as is a huge tax break for the wealthiest people in this country.”
— Sen. Bernie Sanders
“I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid,” Donald Trump tweeted on May 7, 2015. “Huckabee copied me.”
For once, Trump was telling the truth — except for lying about Huckabee. He did make that promise. In fact, he made it repeatedly, in various forms.
“I am going to take care of everybody,” Trump told 60 Minutes in September 2015. “Everybody’s going to be taken care of much better than they’re taken care of now.”
Trump also promised lower costs.
“We’re going to replace it [Obamacare] with something that’s going to be great, that’s a lot less expensive for you, and a lot less expensive, frankly, for the government,” he told a rally in South Carolina the following month.
But now Trump is breaking those promises by embracing the House GOP repeal plan. This could break the GOP as well, unless they’re very, very good at pulling the wool over people’s eyes.
So far, however, people just aren’t buying it, with mobs of constituents showing up at town hall meetings and organizational opposition coming from everyone and his dog. This opposition is led by top-name groups, including the American Medical Association, AARP and the American Hospital Association, along with dozens of others representing doctors, nurses, patients and hospitals — even small business owners.
The GOP plan — (Paul) Ryancare, Trumpcare, whatever you call it — would take coverage away from tens of millions of people, including as many as 11 million on Medicaid. It would also raise costs and cut benefits for the majority of other Americans. This includes the 44 million Americans on Medicare, who now get free preventative care under Obamacare and an average annual savings of $700.
The 38-million-member AARP called the GOP’s bill a “bitter pill for older Americans” and a “giveaway to insurers and drug companies.” In its letter to Congress opposing the bill, AARP wrote:
This bill would weaken Medicare’s fiscal sustainability, dramatically increase health care costs for Americans aged 50-64, and put at risk the health care of millions of children and adults with disabilities, and poor seniors who depend on the Medicaid program for long-term services and supports and other benefits.
Whatever happens next, it’s bound to be messy. But there is one way to make sense of things: by contrasting what the GOP is doing now with how German conservatives created the first universal healthcare plan in the 1880s. That’s right: the very first “socialist” healthcare system was created by conservatives almost 140 years ago.
German conservatives had always been in charge of running things, although a unified Germany was something brand new. Chancellor Otto von Bismarck decided to steal the socialists’ most popular idea — universal health care — and structure it to meet a variety of different conservative goals. For industrial capitalists, it would make German industry more competitive (especially against England) while building worker’s company loyalty; for nationalists, it would stem emigration to America while building a national identity; and for cultural conservatives, it would strengthened paternalistic values and the Protestant work ethic. To accomplish these things, of course, it had to actually work. And it did.
American conservatives, in contrast, haven’t held unified national power — the White House and both chambers of Congress — since the Great Depression, except for a few years under George W. Bush. This brief time in power ended so catastrophically that it created a conservative identity crisis that’s still going on today — with Tea Partiers, Wall Street conservatives, white nationalists and others each fighting for the title of “true conservative.” Despite their differences, they share one thing in common: Their principles are overwhelmingly not practical — they are expressive and ideological and thus, very ill-suited for shaping comprehensive pragmatic policy on virtually anything. As a result, the plan the party has come up with satisfies different specific conservative factions — just as Bismarck’s plan did — but without any attention to how things actually will function in reality.
In January, before the GOP’s plan was unveiled, a study from the Milken Institute School of Public Health at George Washington University warned that repeal of two key provisions of Obamacare could lead to the loss of 2.6 million jobs in 2019 alone, rising to almost 3 million by 2021. Bismarck would have taken that study seriously. Trump and Ryan have not. Instead, here’s the reality of what they’re proposing to do:
First, the Trump/Ryan plan is a massive tax cut for the rich. An analysis released by the Joint Committee on Taxation projected almost $600 billion in tax cuts through 2026, of which almost half would go to wealthy Americans. Those in the top 0.1 percent would get an annual average tax cut of almost $200,000.
Second, it’s a decimating attack on the welfare state and the millions of low- and middle-income Americans it protects and serves. Medicaid cuts through 2026 — $560 billion, according the Center on Budget and Policy Priorities — would almost exactly match the tax cuts. So, the poor lose their health care to line the pockets of the super-rich, with a sprinkling of crumbs for the upper middle class. The Medicaid cuts are twofold: first, the Medicaid expansion under Obamacare is halted, shifting massive amounts of costs onto the states; and second, Medicaid is turned into a per-capita block-grant. It will no longer cover a fixed percentage of the states’ costs, and the block-grant’s future growth won’t keep up as those costs increase. These cuts will force millions of recipients to lose coverage; they will also severely hurt state governments, rather than empowering them, as GOP rhetoric claims to do.
Medicare is also targeted, though more diffusely, setting it up for future attacks. In its letter, AARP noted both how Obamacare had strengthened Medicare’s solvency and how the GOP replacement would weaken it:
According to the 2016 Medicare Trustees report, the Medicare Part A Trust fund is solvent until 2028 (11 years longer than pre-Affordable Care Act (ACA)), due in large part to changes made in the ACA. We have serious concerns that the American Health Care Act repeals provisions in current law that have strengthened Medicare’s fiscal outlook, specifically, the repeal of the additional 0.9 percent payroll tax on higher-income workers. Repealing this provision could hasten the insolvency of Medicare by up to 4 years and diminish Medicare’s ability to pay for services in the future.
Third, this new act will restructure the individual insurance marketplace in a way that increases costs for most consumers, especially those who can least afford it. It also hits Trump voters the hardest. According to a Keyser Family Foundation analysis, subsidies wouldn’t decline for everyone everywhere, but subsidies would decline in 81 percent of counties that voted for Clinton in 2016 and in 93 percent of counties that voted for Trump. What’s more, those gaining $2,500 or more in subsidies split 47 to 46 for Clinton, while those set to lose $5,000 to $7,500 voted overwhelming — 60 to 35 percent — for Trump.
The Impact of American Health Care Act
Kaiser Family Foundation has an interactive map illustrating the impacts nationwide on a county-level basis. For a 60-year old making $75,000 or $100,000 a year, the map is all reddish brown, meaning larger tax cuts from the GOP plan. But for those making $50,000 a year, most of the map is blue, meaning smaller tax cuts. For those making $30,000 a year, only a handful of counties in Texas and Massachusetts, two in Indiana, and much of upstate New York remain reddish brown. For those making $20,000 a year, no counties remain reddish brown.
Things are not quite as bleak for 40-year olds or 27-year olds, but that’s just the point: older people average higher health costs and should be better protected because of it. Instead, as AARP told Congress, the GOP plan imposes “an unaffordable age tax.”
Fourth, it’s an attack on women’s health and freedom. As summarized by the Associated Press, it includes a one-year freeze (easily extended) on Planned Parenthood funding, depriving 2.5 million current patients of birth control and mammograms; it bars the use of new federal tax credits to purchase plans that cover choice in abortion; and the Medicaid cuts affect mammograms as well as prenatal and newborn care. In many places, Planned Parenthood is the only provider available for low-income women’s healthcare. For all the GOP’s constant talk about “freedom” and providing Americans with “choice,” what they have in mind for women is the exact opposite.
Fifth, it’s an indulgence in moral scolding. Despite being so proud of how short their bill was, House Republicans devoted six of its 66 pages — almost one-tenth of the document — to “a new rule allowing states to deny Medicaid coverage to lottery winners,” a miniscule cost problem, which could have been dealt with in a single paragraph, at most.
This last point is particularly telling for the light it sheds on the profound difference between American conservatives and conservatives elsewhere, like Bismarck. He would have handled it in single sentence.
The GOP’s obsession with abstract values over real consequences was summed up perfectly on Meet The Press on March 12, when Chuck Todd presented the following challenge to Trump’s Secretary of Health and Human Services, Tom Price:
In Fayette County, West Virginia, this is one example, Keyser Family Foundation estimates the following: that the $4,000 tax credit that a 60-year old making $30,000 a year will get under the American Health Care Act [Trumpcare] is almost $8,000 less than they would get under Obamacare. This is a county, by the way, that voted overwhelmingly for President Trump. The point is this: You say it’s going to make it more affordable, under this plan, in this county, in this state, less money and more expensive for these folks.
“Who knows what that 60-year-old wants?” Price said in response, “I know that the federal government doesn’t know what that 60-year-old wants. I know that he or she knows what he or she wants.”
Who needs healthcare, when you can have freedom from government providing for the general welfare instead?