Since Senate Majority Leader Mitch McConnell (R-Ky.) blinked and put off a vote on his health care bill last week, there’s been a lot of chatter about the wheeling and dealing going on behind the scenes.
With so much at stake and with all the action ― or at least the illusion of action — being reported, it can be easy to miss the forest for the trees, so a crucial thing bears re-emphasizing:
Whatever bill McConnell and 49 other members of the Senate Republican Conference deem acceptable to bring to the floor will not fundamentally differ from the staggeringly unpopular bill they fled Washington to escape before Independence Day and that made them avoid their constituents over the holiday break.
Sure, there’s been a lot of noise. They’re close to a deal! They’re not! McConnell has hundreds of billions of dollars to dole out to placate reluctant Republicans! President Donald Trump says just repeal it first and figure out the rest later! The White House is having some rallies, or something!
That all seems to be true, as far as it goes. McConnell came up short of the 50 votes he needed to move ahead with the Better Care Reconciliation Act, forcing him to go back to the drawing board for a revised plan to repeal and “replace” the Affordable Care Act. There are many trial balloons aloft.
The tweaks various Republican senators are suggesting and that the White House and GOP leadership are floating appear designed more as new talking points to answer specific criticisms of the bill than as real responses to those criticisms.
Like the underlying bill itself, none of these things would actually solve the problems with the American health care system, including those the Affordable Care Act didn’t address, failed to correct or worsened. And this legislation in any form would undermine that law’s successes, like its extension of health coverage to 20 million people and its reduction of the uninsured rate to an all-time low.
Unless McConnell, Trump, House Speaker Paul Ryan (R-Wis.) and every other Republican in Congress experiences the kind of stunning change of heart normally seen only among stingy businessmen at the end of old children’s movies, their shared goals remain the same: enact hundreds of billions of dollars in tax cuts for wealthy households and health care corporations (and, uh, tanning salons) and pay for those by gutting Medicaid and drastically scaling back financial assistance for private insurance and consumer protections for insurance customers.
If a health care bill makes it to the Senate floor with enough support to go back to the House and then to Trump’s desk for a signature, it will have the same fundamental effects as the version that couldn’t get 50 votes last week.
It will still slash Medicaid spending by more than 30 percent over the next two decades, resulting in 14 million fewer people covered by that program in the next 10 years and likely even more further down the line as states make cuts to coverage and benefits in response to less federal support.
It will still replace the Affordable Care Act’s tax credits for private insurance with smaller ones available to fewer people, forcing millions to pay more or go without.
It will still weaken the rules that not only guarantee access to health coverage for everyone ― regardless of their health status, pre-existing conditions and medical histories ― but also that also guarantee the insurance will actually cover the medical care they need.
It will still lead to higher deductibles and other out-of-pocket costs.
It will still ask older, poorer people to pay more than they can afford ― or even more than they actually earn in a year ― for health insurance. This is the main way the bill seeks to lower premiums for the younger and wealthier people who need help the least.
It will still repeal taxes on people and companies that already are plenty flush.
And it will still increase the number of Americans who don’t have health coverage, and therefore access to lifesaving care, by about 20 million over the next 10 years.
There’s a simple reason we can be sure about this without knowing whatever might come out of the backroom deals underway: The results described above aren’t the unintended consequences of the Better Care Reconciliation Act or the House-passed American Health Care Act. They are the explicit purpose of those bills.
The priority that underlies all the various Republican health care proposals we’ve seen this year is to shrink the social safety net and return the money currently financing it to the rich and to big business.
Raising taxes to pay for less fortunate people to access health care is anathema to conservative ideology. Despite the expressions of concern for those people who have gone unaided or even been harmed by the Affordable Care Act, that’s the real reason why the GOP is so disgusted by this law and has spent the past seven years trying to tear it down.
And if you believe that taxation is theft and that it’s not the government’s concern if citizens are suffering from illness and injury, any bill you can vote for is one that would conform federal policy to that philosophy.
No amount of opioid-treatment money or funding for high-risk pools or relaxed regulations on health savings accounts can make up for that.
In the end, there may be enough Republican senators willing to pretend it does that this legislation can pass. But it won’t make it true.