New Trumpcare just lipstick on a pig

Mitch McConnell seems to have forgotten what they say about putting lipstick on a pig.

As most people know, it doesn’t make the pig pretty.

The cosmetics that the Senate Majority Leader has dabbed on his misnamed “Better Care” bill improve it in some ways but make it significantly worse in others.

Gone are some, but not all, of the tax cuts that would have drained the Medicare Part A trust fund two years sooner. There is more money for subsidies and to fight opioid addiction. People who have money to put aside in tax-exempt health savings plans could use it them to pay insurance premiums.

But Trumpcare — or McConnellcare if you prefer — still scraps the core provision of Obamacare, the requirement that everyone who can afford it must have health insurance or pay a tax. With fewer healthy people — those who are most likely to skip out — it will cost more to insure everyone else.

In its place, McConnell adopts one of Ted Cruz’s worst ideas, a scheme to let some companies on the public exchanges sell policies that don’t meet Obamacare’s minimum standards. For example, plans without pregnancy coverage would have an obvious appeal to the sort of man who doesn’t mind making women pay more if it lets him pay less.

Polls show the public, including most men, strongly opposed to this. But Marco Rubio, Florida’s junior senator, says he likes it. Translation: He’s pathetically eager to give Donald Trump something to sign, no matter the human toll.

Allowing the sale of inadequate policies has malicious consequences. It tempts some to buy coverage that will fail them in the event of serious or costly injury or illness. It’s also a sly way of denying coverage to people with pre-existing conditions and allowing them to be dropped when they’re sick. Policies might still be available, but few could afford them with young and healthy people no longer in the mix.

Worst of all, McConnell continues to use the Republican Party’s manic obsession with repealing Obamacare as a pretext to begin the destruction of Medicaid. He targets not just the expansion voted in 2010, which would still be rolled back, but also the basic program itself.

Instead of the present stated percentage match to what states are willing to spend for covered services, payments to states would be fixed on a per capita basis and indexed for growth at less than the actual rate of inflation in the economy’s health care sector.

So states would get the onus of cutting services. But to whom?

To the 1.8 million Florida children who depend on Medicaid?

To the more than 350,000 Floridians who are battling mental illness and/or substance abuse with support from Medicaid that they could find nowhere else?

To low-income Medicare patients in nursing homes, of whom two out of three are subsidized all or in part by Medicaid?

McConnell is said to be trying to beguile skeptical Republicans into believing that it won’t necessarily happen. The destruction of original Medicaid would begin not immediately, but in 2026 — nearly nine years and four election cycles distant. So there would be time to undo that damage.

That’s snake oil. Put off the consequences so that those responsible won’t have to account for them. In the meantime, perhaps, divert the Medicaid “savings” to tax cuts for McConnell’s true constituency, the one percent.

We have yet to hear from the Congressional Budget Office how McConnell’s closed-door negotiations affect its earlier estimate that some 22 million more people would eventually lose or be forced to go without health coverage.

The actual numbers, dreadful as they may still be, are almost beside the point. Congress should be talking instead about making Obamacare better in ways upon which both parties might agree. It should start from the premise that everyone in a modern democracy has a birthright to affordable, quality health care.

A Republican congressman from Texas remarked recently that “an individual mandate has no place in a free society.” Really? Social Security and Medicare are mandates. You don’t have to accept the benefits, but you do have to pay the taxes. The systems wouldn’t work otherwise. States mandate motorists to purchase liability insurance. The list is long. It’s all part of the social contract that helped separate modern times from the Middle Ages, and upon which most nations have been trying to improve. Health care belongs in that contract.

McConnell’s pig is nowhere near pretty. It’s repulsively ugly, and whatever lipstick they might slap on in floor debate can’t make it any less so.

The only responsible vote for Marco Rubio and other senators this week is to refuse to bring it to the floor. The entire issue should be referred to a committee for public testimony, public debate and thoughtful preparation, which is how our government was meant to work.