The GOP health-care bill: Now meaner, and with less heart

President Trump is reportedly worried that the House GOP's health-care bill is too "mean." He wants the Senate version to have "more heart."

But if anything, the Senate's in-progress bill is even meaner than what narrowly eked its way through the House.

Back in late March, House Republicans' quest to repeal and replace ObamaCare looked dead in the water. A month or so later, they'd passed TrumpCare 2.0. But it also looked like GOP moderates in the Senate would never stand for this incredibly harsh health-care bill, which promised to toss millions of Americans off their health insurance. Yet now, barely a month after House passage, the Senate's GOP moderates have effectively folded, and the Senate plans to ram through a bill remarkably similar to the House's — just meaner and with less heart.

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It boils down to Medicaid, the government health insurance program for low-income Americans, which is jointly funded by the state and federal governments. It's the feds, however, that provide the bulk of the money.

ObamaCare dramatically expanded Medicaid, mostly on the federal government's dime. The House GOP's bill would scrap that expansion. The Senate wants to slow down the expansion's death by a few years — and then get even more extreme.

As is, Medicaid's spending is open-ended: A certain number of people qualify for the program, and the federal government spends whatever it has to spend to provide them a certain suite of benefits. The House GOP would hold the growth of Medicaid's spending to the inflation rate of prices in the medical sector overall. But Medicaid's population is considerably poorer and sicker than the overall population of Americans who buy health care. So its spending rises faster than aggregate medical prices. As such, the new rate cap would be a massive cut to the federal support states were expecting: over $830 billion in the first decade — a whopping one-fourth of all federal spending on the program.

The Senate version of TrumpCare will reportedly initially give states more flexibilty before dropping to the medical inflation rate. But then in 2025, the Senate plan would drop federal Medicaid spending to an even slower growth rate: the inflation rate for the entire economy. Over time, the Senate plan's spending rate would result in much larger cuts than the House's already-massive axing.

Now, we don't actually have the text of the Senate bill yet. Things could still conceivably change. But so far, it doesn't look good.

So why would the Senate, supposedly the more moderate and deliberative body, double-down on the House's brutality on this issue?

The most likely explanation is that Senate Majority Leader Mitch McConnell and the rest of the Republican high command just want this over with.

The more time and political capital they spend trying to repeal and replace ObamaCare, the longer they delay their chances of enacting "tax reform" — i.e. massive tax cuts for the rich. At this point, that's basically the Republican Party's entire raison d'être. You can see that in TrumpCare itself. Most of the cuts to Medicaid fund $664 billion in tax cuts for high-earners and medical businesses. TrumpCare takes help away from children, the disabled, the elderly, and the poor to hand even more money to the powerful. And if McConnell and the GOP can't get their tax-cut-in-disguise via TrumpCare, they want to move on to the real thing as rapidly as possible.

McConnell is using the slow phase-in to keep the moderates on board, and the deeper cuts to keep the ideologues happy. And he's ramming the whole thing through as quickly and with as little public discussion as possible, because the longer this drags out the more likely it becomes that fragile coalition may split apart. The moderates in particular seem to be hoping that if the cuts get pushed far enough out in the future, they can avoid too much political backlash from their own voters.

Which is also why Senate Democrats, while they don't have the votes to kill the bill, are trying to slow it down. The CBO score should arrive early next week, and then the Senate will vote next Thursday. Maybe, just maybe, the Democrats can buy more time for public pressure on the Senate GOP moderates to build.

This is the GOP's Hail Mary pass. When people are desperate, they show you who they really are, and what they really stand for. And this abdominable bill is showing us an awful lot about the Senate's so-called moderates.