Rubio, consider ‘First, do no harm’

It is a wicked piece ofwork that majority leader MitchMcConnell has been trying to ramthrough the Senate to strip 22 million Americans of health insurance and inflict inferior coverage and higher out-of-pocket expenses on millions more. The delay he was forced to accept Tuesday until after the July 4 recess should be followed by defeat. The bill is too bad to be made good with amendments.

No legislation in modern memory has had so muchwrong with it, starting with the deceit built into its title. It is the opposite of a “Better Care” bill. It is, rather, a $1 trillion tax cut, mostly for the benefit of wealthy people and corporations, to be paid for with ill health and financial hardship for many others. What somemight save in premiumswould be overcome by skimpier benefits and higher deductibles.

Former President Barack Obama, who created the Affordable CareAct thatMcConnell is desperate to destroy, did not overstate in calling the proposed legislation “fundamental meanness.”

Although Donald Trump called the House bill “mean” and asked for one with “heart,” he is on board withMcConnell. His campaign promises to protectMedicaid andMedicare are just more broken shards. The outcome will still turn on the fortitude of a few Republican senators who can deny McConnell a majority. He has been offering quick fixes to benefit certain states, but the bill is too flawed for such patchwork. It should be killed outright or sent to a committee for the public testimony and careful review hewas unwilling to permit.

Marco Rubio should join Florida’s senior senator, BillNelson, in opposition to this bill. If he can’t get there on principle, Rubio might at least recognize the particular dangers it poses to Florida. Some 4.3 million Floridians benefit fromMedicaid and the Children’sHealth Insurance Program. Florida has 4millionMedicare enrollees, and16 million people whose future benefits — earned and paid for— are in jeopardy. This is especially critical for nursing home patients and their families.

The block grant scheme is especially dangerous. As former senator BobGraham explains this issue, using the highway trust fund as an example, block grants typically disfavor large and growing states in two ways. There are guaranteed minimums for smaller states and holdharmless provisions for low-growth or nogrowth states. The money comes off the top at the expense of states like Florida. Floridawould suffer disproportionately, “almost without question,” Graham says.

McConnell’s steamroller ran lowon fuel. But it’s no time for citizens to let up. TheRepublican campaign to eraseObama’s historic achievement shows no signs of relenting. The effort must be killed “Black Flag dead,” as Florida Congresswoman CarrieMeek used to say. Only then could there be, as there should be, a sincere attempt to improve Obamacare and lower costs.

Every other industrial nation treats health care as a fundamental right of life. It is hard to understand howMcConnell and his party could even entertain a plan that would leave 49 million people uninsured— the Congressional Budget Office estimate— by 2026. For comparison, that is more than the entire populations of Canada or Spain. The destructiveness goes beyond that. McConnell’s scheme cuts 15 million people offMedicaid and gravely damages the program in the longer term by switching it to block grants based on population, with a formula calculated to lag ever further behind medical cost inflation. Medicaid beneficiaries are primarily poor, children, pregnant and the elderly. Medicaid pays all or in part for two of every three Medicare enrollees in nursing homes. The bill also threatensMedicare by repealing Obamacare’s earmarked taxes onwealthy people and medical suppliers; the PartAtrust fund would run dry in 2026, two years sooner.

It erodes the very foundation of Obamacare by eliminating the requirement that those who can afford it must purchase insurance or pay a tax. Those who go without would face a six-month wait when they eventually apply— a late addition to the Senate plan— but this could be lethal for someone who falls seriously ill.

If fewer healthy people pay premiums, others necessarily paymore. That can lead to a death spiral which would be aggravated by other aspects of the bill. The budget office cautioned that by 2020, premiums and deductibleswould become so severe that “few low-income peoplewould purchase any plan.” The impactwould be especially hard on those between 50 and 64, too young forMedicare. The out-of-pocket cost of a typical subsidized plan nowcosting $1,700 to a 64-year-oldwould more than triple to $6,500, and cover less, according to the CBO.

Polls showed theHouse version to be unpopular in every state. McConnell’s is evenworse. Virtually everymajor health organization opposes the bill. Citing medicine’s ancient admonition, “First, do no harm,” the AmericanMedical Association toldMcConnell onMonday that his bill “violates that standard on many levels.”

Aspiteful provision bansMedicaid recipients fromusing their coverage at Planned Parenthood clinics. TheAMAtook particular exception to that as an offense against “patients’ freedom to choose their providers and physicians’ freedom to practice in the setting of their choice.”

The billwould also allowstates to requestwaivers from10 essential health care services, including office visits, emergency treatment, mental health, birth control and pregnancy.

There is more here than a clash of the moment. It is a classic conflict of principles between the Republican aversion to the social safety net and theDemocratic Party’s instinct to support and improve it. If this assault succeeds, is Social Security next? The answer, quite likely, is yes.

Meanness is not an acceptable national policy. Not here. Not anywhere. Marco Rubio will likely never cast a more important vote. He can toady forMcConnell and Trump or he can stand up for the people of Florida. There is no middle in this road.

For Floridians who care, the time to tell Rubio is now. His telephone number in Washington is 202-224-3041. At his Palm Beach office, the number is 561-775-3360. If he surfaces anywhere near during the recess, tell him in person.

Editorials are the opinion of the Sun Sentinel Editorial Board and written by one of its members or a designee. The Editorial Board consists of Editorial Page Editor Rosemary O’Hara, AndrewAbramson, Elana Simms, Gary Stein and Editor-in-ChiefHoward Saltz.