Too often, we think of politics as a game, losing ourselves in the personalities and the strategies and the winning and losing. But the reason it matters in the first place is that all of our lives are affected by politics, by who holds power and what decisions they make. And in those decisions, lawmakers reveal themselves. They show us what — and who — is important to them. Republicans and Democrats aren't just opposing teams, like the Yankees and Red Sox. They represent two alternate visions of the world and two very different moral systems.
While those contrasting moralities express themselves every day in ways large and small, every once in a while a party gets the opportunity to make a grand statement about what it believes. That's what Republicans in the Senate did this week when they released their version of a health-care bill. If you want to know what today's GOP is all about, you can find the answer woven through that bill's pages.
Let's begin with one of the party's two great goals, one that extends beyond this bill to other issues like taxes and regulation. That goal is to make life as easy and pleasant as possible for the wealthy, those "job creators" whose virtue is proven by the size of their bank accounts. The Senate's bill gives them a cornucopia of benefits, rolling back the tax increases that were contained in the Affordable Care Act, to the tune of hundreds of billions of dollars. One cut, on investment taxes, would even be made retroactive to the beginning of the year, just to put something extra in the wealthy's pockets. There are a couple of more little goodies in there, like the repeal of an ACA provision that limited the tax deduction for insurance company CEO pay to the first $500,000. The Republicans who wrote the bill were being very thoughtful.
Then there's Medicaid, the bill's most prominent target for assault. It also not only eliminates the ACA's expansion of Medicaid, phasing it out beginning in 2021, but goes much farther. Medicaid would no longer be an "entitlement," which means that anyone who meets the eligibility criteria gets the benefit, even if in some years that means its budget gets unexpectedly bigger. Instead, Medicaid would be subject to new, slow-growing per capita caps, which represents hundreds of billions in cuts in coming years. In addition, states would be given "flexibility" over whom they cover, meaning they'd be allowed to reduce benefits or kick people off the program entirely. And who are the beneficiaries of Medicaid? The poor, the disabled, and the elderly (even though they get coverage through Medicare, Medicaid pays for a large portion of the country's nursing home expenses). These are the people to whom the GOP is showing the back of its hand so it can offer a large tax cut to the rich.
That's not all. While the bill maintains the basic structure of the ACA subsidies that allow people not poor enough for Medicaid to be able to afford insurance, it makes them stingier, reducing the highest income at which people can receive the subsidies and cutting the subsidies' amount, so they're pegged to what it would take for you to buy a less expensive plan with higher deductibles. That's right, higher deductibles — which everyone hates and Republicans used as a way of attacking the ACA. This bill encourages them. It eliminates subsidies for out-of-pocket costs for low-income people, all but guaranteeing they'll be forced into high-deductible plans.
The bill also allows states to opt out of the ACA's "essential health benefits" requirement, meaning insurers would once again be free to offer cheap plans that cover very little. Ending the EHB requirement could be a backdoor way of gutting the protection people with pre-existing conditions now enjoy — if insurers can offer you bare-bones plans, then the guarantee that you'll be covered for your pre-existing conditions will cease to mean very much. It also allows states to seek waivers for the ACA's outlawing of annual and lifetime limits on coverage, which threatens the security of everyone who has an employer-provided plan. The bill allows insurers to charge more to older people, and bars women on Medicaid from getting care at Planned Parenthood for one year.
So let's review:
- The wealthy get a huge tax break
- Millions of poor and middle-class people lose health coverage altogether
- Medicaid is gutted and hobbled
- Fewer people get insurance subsidies, and those subsidies are smaller
What does it say about the values and priorities of the people who wrote this bill, and the people who will vote for it? It says that they are deeply concerned about maximizing the wealth of the wealthy — so concerned, in fact, that they're willing to take away health coverage from millions of people in order to provide the wealthy a large tax cut. It says that they think that poor people have it too easy. It says that they believe health care is a privilege, not a right — if you can afford it, good for you, but if you can't, too damn bad. And it says that their vision of America's health-care future is one that is surpassingly cruel, where alone among the world's industrialized democracies, we'll intentionally leave millions of our citizens without health coverage and allow them to be bankrupted by medical bills.
In trying to defend this monstrosity — and whatever compromise Senate Republicans can make with their House counterparts, whose bill was even more vicious — Republicans will say that they share the same goals on health care as anyone else, a system that is affordable and comprehensive and protects everyone. Don't believe it for a second.