TrumpCare is class warfare

Class warfare is bad, and you shouldn't engage in it. That's been a consistent talking point among Republicans for years.

Back in 2011, when President Obama tried to raise taxes on wealthy investors who pay extraordinarily low rates, GOP stalwarts from Newt Gingrich to Paul Ryan threw the "class warfare" epithet at the president, accusing him of dividing the country. In 2016, when the GOP presidential candidates were asked if taxes should be higher on millionaires, they scoffed. New Jersey Gov. Chris Christie called the suggestion — you guessed it — class warfare.

But if raising taxes on the rich is class warfare, what's gutting hundreds of billions of dollars in aid to the poor?

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Because that's just what the Republicans' two health-care bills do. While the details of the American Health Care Act (passed by the House) and the Better Care Reconciliation Act (under debate in the Senate) differ in some particulars, one thing they share is mammoth cuts to Medicaid. That's the government program that provides health insurance coverage for over 72 million low-income Americans — mostly children, retirees, and disabled adults.

The House and Senate bills would cut it by $834 billion and $772 billion, respectively, over the next decade. That's roughly one-fourth of all federal spending on the program, and there's no conceivable way the states could make up the difference.

Now, Republicans have promised for years to "repeal and replace" ObamaCare, including its expansion of Medicaid. But their bills don't stop there. They would cut Medicaid as it existed before ObamaCare, too. Right now it's an open-ended program: Enrollees are promised certain benefits, and the government pays whatever it must to deliver those benefits. The House bill would force federal Medicaid contributions to grow at a set rate, slower than the program's spending has traditionally increased. In 2025, the Senate would lower the cap further. (Despite a smaller reduction in the 10-year budget window, the Senate's Medicaid cuts would actually be much deeper over the long haul.)

Now, maybe someday medical price growth will dramatically and permanently slow, and less spending won't have to mean fewer benefits and enrollees. But there's no evidence of that happening anytime soon. So what would happen under these bills is Medicaid would simply have to buy care for fewer and fewer people over time. The Senate version in particular would eventually reduce the program's federal component to a vestigial organ of the welfare state. To keep their finances stable, states would have no choice but to kick millions off the program.

Admittedly, the GOP does offer a replacement: ObamaCare-style subsidies to pay for private plans instead. But they also slash the subsidies' generosity compared to current law. On top of that, the Senate bill alters the subsidies to favor plans with higher deductibles. And the Republicans would allow states to deregulate insurance markets, so insurers could cover fewer drugs, procedures, and services.

Medicaid is not perfect — its doctor networks can be narrow. But most Americans who have it are happy with the coverage it provides: Its out-of-pocket costs, like its deductibles, are low or non-existent. The Republican bills would replace them with annual premium payments and deductibles that are many thousands of dollars higher. Under the Senate bill, someone on Medicaid making 75 percent of the poverty line would face a deductible over half their annual income.

It's not hard to imagine what will happen next: Poor Americans will be forced to make impossible trade-offs. Their child's education or their child's insulin shots; the rent or dad's cancer treatment. Because Medicaid offers something close to free health care, it releases money in the budgets of poor and working-class households for other needs: school, clothes, food, transportation, better living conditions, etc. It gives them more safety to try for something better in life — to demand higher pay or more dignified working conditions — because they know they'll at least have their medical bills covered if they lose their job. The GOP's health-care bills would strip all that away from millions of people.

Republican politicians have gotten angry over accusations that their bills will kill people. And yes, gaming out just how many deaths would result is statistically tricky. But come on. What's unquestionable is that the amount of raw human misery in America — the loss and desperation and fear and hopelessness and degradation — would increase massively. And the vast bulk of that pain would fall on the poorest and least-fortunate of our fellow citizens.

Not in their most fevered imaginations do left-wing tax-hikers envision inflicting this kind of suffering on the 1 percent. Even Bernie Sanders' ambitious tax platform would have, at most, reduced the "unimaginably wealthy" to the "merely rich" or "solidly upper class."

Now, obviously, no policy is perfect. Even the most well-designed law, conceived with the most honorable intentions, will have downsides and create losers. All of politics — just like all of life — is trade-offs. So what's the trade-off here? What do the Republicans buy us with all this pain and suffering?

In the House bill, it's $664 billion in tax cuts for wealthy Americans and businesses. In the Senate bill, it's $541 billion in tax cuts. Oh, and $119 billion and $321 billion in deficit reduction, respectively. Indeed, the 400 richest American families alone would get $33 billion in tax benefits between 2019 and 2028 — enough money to cover the Medicaid expansion for 725,800 people. I think it goes without saying that they don't need the cash. But I'd point out that we don't need the deficit reduction either: Interest rates and inflation rates remain at near-historic lows. We have all the room in the world to borrow. And it's hard to think of any priority worthier of investment than health care for our poorest fellow citizens.

So this is what the Republican Party stands for: The idea that America gives far too much money to sick kids and struggling single moms and families mortgaging their homes to pay for a grandparent's nursing home. And that America does not give nearly enough to its glittering aristocracy.

The GOP actually thinks "class warfare" is quite necessary. It just needs to be waged on behalf of the rich against the poor.