The GOP health care con

Denying health insurance to millions is one of the goals

Afew days ago the tweeter-in-chief demanded that Congress enact “a beautiful new Health Care bill” before it goes into recess. Now we’ve seen Mitch McConnell’s latest version of health “reform,” and “beautiful” is hardly the word for it. It’s ugly, intellectually and morally.

First, let’s talk about the one piece of the bill that may sound like a step in the right direction, and why it’s largely a scam.

The original Senate bill got a lot of justified bad press for slashing Medicaid while offering big tax cuts for the rich. This version rolls back some of those tax cuts, which sounds like a concession to moderates.

However, the bill also would allow people to use tax-favored health savings accounts to pay insurance premiums. This would create a big new tax shelter that mostly helps people with high incomes who (a) can afford to put a lot of money into such accounts and (b) face high marginal tax rates, and hence get big tax savings.

So this is still a bill that takes from the poor to give to the rich; it just does so with extra stealth.

How does he address the two big problems with the original bill — savage cuts to Medicaid and soaring premiums for older, less affluent workers? He doesn’t.

Brutal Medicaid cuts are still part of the plan, though desperate Republicans pretend that they aren’t. The subsidy cuts that would send premiums soaring for millions remain in the bill as well.

The good stuff, such as it is, involves some new money for the opioid crisis, but not nearly enough for patients at high risk, and some additional aid for insurers — the same thing Republicans denounced as outrageous corporate welfare when Democrats did it.

The most important change, however, is the way the bill would effectively gut protection for people with pre-existing medical conditions. The Affordable Care Act put minimum standards on the kinds of policies insurers could offer; the new Senate bill gives in to demands by Ted Cruz that insurers be allowed to offer skimpy plans that cover little, with very high deductibles that would make them useless to most people.

The effects would be disastrous, which is what insurers themselves say. In a special memo, AHIP, the insurance industry trade group, warned that it would “fracture and segment insurance markets into separate risk pools,” leading to “unstable health insurance markets” in which people with pre-existing conditions would lose coverage or have plans that were “far more expensive” than under Obamacare.

Put another way, this bill would send insurance markets into a classic death spiral. Republicans have predicted such a spiral for years, but kept being wrong: Obamacare, despite having some real problems, is stabilizing, and doing pretty well in states that support it. This bill would sabotage all that progress.

Many victims of this sabotage would be members of the white working class, people who voted for Donald Trump, believing him when he promised no cuts to Medicaid and better, cheaper insurance for everyone. So why are Republican leaders pushing this?

The main answer, is that Republicans all along have wanted a big decline in the number of Americans with health insurance and a sharp reduction in the quality of coverage for those who keep it.

During the eight-year jihad against the Affordable Care Act, the GOP of course pretended otherwise: denouncing Obamacare for failing to cover everyone, attacking the high out-ofpocket expenses associated with many of its policies, and so on. But conservative ideology always denied the proposition that people are entitled to health care; the Republican elite still consider people on Medicaid, in particular, as “takers” who steal from the deserving rich.

The conservative view has always been that Americans with health care should pay more in deductibles and co-pays, giving them “skin in the game,” and thus an incentive to control costs.

So what we’re seeing here is the last act in a long con, the moment when the fraudsters cash in and their victims discover how completely they’ve been fooled. The only question is whether they’ll get away with it. We’ll find out soon.

Paul Krugman is a columnist for The New York Times.