The devolution of repeal-and-replace
WASHINGTON — Motivated by the cynical aims of fulfilling a bumper-sticker campaign promise and lavishing tax cuts on the wealthy, Republicans are threatening to pass a health care bill they know will make millions of Americans sicker and poorer. Do they think we don’t see what they’re doing?
Does Sen. Chuck Grassley, R-Iowa, think we didn’t hear what he said Wednesday? “You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” he told reporters. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign.
That’s pretty much as much of a reason as the substance of the bill.”
There you have it: Who cares what this legislation would do? Vote for it anyway.
The GOP’s efforts to repeal and replace the Affordable Care Act have undergone a process of devolution, with each new bill worse than the last. The measure that the
Senate plans to vote on next week essentially takes away most of the protections, benefits and funding of the ACA, but leaves in place most of the taxes.
That’s supposed to be good politics? Seriously?
In his desperate haste, Majority Leader Mitch McConnell has decided not to wait for the nonpartisan Congressional Budget Office to analyze the bill before bringing it to the Senate floor. The CBO estimated that July’s Better Care Reconciliation Act, which would have repealed the ACA with a vague promise to replace it later, would have caused 32 million people to lose health insurance coverage. Some outside experts fear the impact of this new bill could be even worse.
I should acknowledge that the measure — sponsored by Sens. Lindsey Graham, R-S.C., Bill Cassidy, R-La., Dean Heller, R-Nev., and Ron Johnson, R-Wisc. — would do one popular thing: Eliminate the requirement that individuals purchase health insurance or pay a fine. But the list of things that people surely won’t like is staggering.
Perhaps chief among them is that the bill eliminates the ACA’s guarantee of affordable health insurance for people with pre-existing medical conditions such as diabetes, heart disease or cancer. State officials would be able to let insurers charge whatever they wanted to the infirm and the elderly — and also could let insurers reinstitute lifetime caps on coverage.
In practice, this means that the old and the sick could be priced out of the insurance market. And it means that those who are insured but have expensive ailments could see their coverage expire after a certain dollar amount had been paid in benefits.
At first glance, this looks like a gigantic gift to the insurance industry. But the powerful lobbying group America’s Health Insurance Plans came out strongly against the bill Wednesday, saying it “would have real consequences on consumers and patients by further destabilizing the individual market.” The Blue Cross Blue Shield Association opposes the measure as well, saying it would “increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans.”
The American Medical Association, the American Hospital Association and AARP adamantly oppose the new Senate bill as well. In fact, it is hard to find anyone who knows anything about health insurance who likes this monstrous creation.
And I haven’t even mentioned the worst thing about the bill: It revokes the ACA’s expansion of the Medicaid program, which provided health coverage for millions of the working poor, and turns Medicaid into an underfunded block-grant program to be administered by the states. GOP rhetoric about federalism and local control is smoke designed to obscure the real goal, which is to dramatically slash the federal contribution toward Medicaid.
In the short term, billions of health care dollars would effectively be transferred from states that participated in Medicaid expansion, such as California, to states that did not, such as Texas. In the long term, however, all states would suffer from inadequate federal funding of Medicaid, which is the primary payer for about two-thirds of nursing-home residents nationwide.
There is a rational motive for all of this, although it’s a nefarious one that the GOP doesn’t like to talk about: Slashing Medicaid spending would make room for huge tax cuts that primarily benefit the rich. Yes, senators, we see that, too.
It is tempting to let the Republican Party drive itself, Thelma-and-Louise style, off this cliff. But the human impact of the latest repeal-and-replace measure would be too tragic. Call your senator. Make a deafening noise. We must do everything we can to kill this bill.