Latest Republican health care tactic: A sneak attack on people with pre-existing conditions

In the fine print, GOP bill guts coverage of “essential health care benefits,” with devastating consequences

It’s becoming clear that Senate Majority Leader Mitch McConnell’s plan to decimate the American health care system is to tinker around the edges of his bill until, as Charles Pierce of Esquire argued, “you get a CBO score you can plausibly use to con the country, the elite political press, and the mind of Susan Collins into thinking you’re ‘moderating’ the bill.” McConnell is counting on the fact that the press is easily bored and always eager to move onto the next new thing — often meaning whatever President Trump has just said on Twitter — and all he needs is a week of such distractions to pass this stinker under the cover of darkness.

But don’t let the tinkering or assurances that the health care bill is somehow becoming more moderate fool you. Republicans still plan on passing a bill that will lay waste to the protections offered ordinary Americans in the Affordable Care Act, leaving people vulnerable to financial ruin or even death from illnesses or conditions that are covered under existing law.

One of the ways Republicans plan to do this is to gut the part of the Affordable Care Act that guarantees coverage of what are deemed “essential health care benefits.” That sounds like a minor bureaucratic adjustment, but in reality it’s a back-door way to deny coverage to people with pre-existing conditions, limit important and life-saving health services, and force people with expensive conditions to go bankrupt rather than rely on insurance to cover them.

The essential benefits that the Affordable Care Act delineated include 10 categories of care that every insurance plan has to cover. Some of these categories are straightforward things that most insurance plans, whether purchased on the individual market or provided by employers, already covered, such as hospitalization or doctor’s visits. But, as Timothy Jost, a professor at the Washington and Lee University School of Law and an expert on health care law, explained in an interview, prior to the passage of the Affordable Care Act many individually purchased plans skipped major categories of coverage.

“What they didn’t cover was maternity care, mental health and substance use disorder care — and often prescription drug coverage was quite limited,” Jost said. “The ACA also added habilitation care for special needs children.”

Under various versions of the Republican plan, states would be able to apply for waivers to exempt plans sold in their state from this mandated list of essential health care benefits. Republicans have repeatedly insisted that their bill bars discrimination against patients with pre-existing conditions. But as Jost explained, ending essential health care benefits creates a mechanism that allows insurance companies to deny coverage of those pre-existing conditions. You’d be allowed to buy insurance, but it might not pay for the things you really need it for.

“So you got a mental health problem, sorry, we’re happy to insure you, but we don’t cover mental health problems,” Jost said, describing the logic. “You’ve got cancer? We’re happy to insure you. We don’t cover any chemotherapy drugs or we don’t cover radiation therapy.”

Presumably, the reason Republicans want to cut essential health benefits is to lower premiums — which is why we get to hear Republican politicians making cracks about how men don’t need maternity care — but Jost said he believes the mandatory benefits “are really a very small part of the total cost of coverage.”

For instance, as Jost has argued on the Health Affairs blog, ending mandatory maternity coverage “might lower premiums by $8 to $14 per month,” but would force women who are giving birth to pay as much as $30,000 to $50,000 in out-of-pocket expenses.

Most of these effects would be felt by people who buy insurance on the individual market, or who work for small companies employers that offer less expensive plans with skimpier coverage. As Matthew Fiedler, a fellow with the Center for Health Policy in the Brookings Institution’s Economic Studies Program, explained, there’s a poison pill buried in the bill that would also affect people who work for large employers that offer more generous health insurance packages. Repealing mandatory essential health care benefits would mean reintroducing lifetime limits or annual coverage caps for many people on those plans. Which means that a lot of people who thought they had generous, comprehensive insurance plans could still face bankruptcy in the event of a serious illness or accident.

Under the ACA, Fiedler explained, “Insurers can’t put lifetime or annual limits on types of care that are considered essential health benefits. But they can put lifetime or annual limits on things that aren’t essential health benefits. What that means is that when the definition of essential health benefits changes, that can substantially change the scope of the protection against annual or lifetime limits.”

Even if you live in a state that sticks with the old Affordable Care Act definition of essential health benefits, you may not be protected if you work for a large employer, defined as any company or entity with 50 or more employees. That’s because, according to Fielder, a large employer can choose any state’s definition of “essential health benefits.” It doesn’t have to stick to the state where it does most of its business, or where its employees actually live.

“Employers could choose a state that had implemented a very lax definition of essential health benefits and thereby have fairly broad latitude to impose these kinds of limits,” he explained.

So a worker in a state like California or Massachusetts, which is likely to continue to protect essential health care benefits, might find that her employer has instead chosen define essential health care benefits under the terms set by Texas or Mississippi. So while that person’s policy might still cover cancer treatments or maternity care or mental health services, she might find out that in practice her insurance company will not cover nearly as much of the cost as it would have under the ACA.

Because of the ban on lifetime and annual limits, the cap on out-of-pocket spending for patients, and the ban on discrimination based on pre-existing conditions, the Affordable Care Act was able to cut the number of personal bankruptcy filings in the United States by half between 2010 and 2016. By drafting a way for states to opt out of the essential health care benefits mandate, the Republican bill will potentially allow insurance companies to dump those costs back onto the consumer. The number of medical-related bankruptcies could well soar back to pre-Obama levels — if Mitch McConnell can find a moment when we stop paying attention and ram this bill through the Senate.

Amanda Marcotte is a politics writer for Salon. She’s on Twitter @AmandaMarcotte

The face of Republican evil: It’s not Donald Trump

Mitch McConnell’s gruesome health care scam reveals the corrupt, antidemocratic character of the entire GOP

In the hellish months since Donald Trump’s inauguration, a dark parlor game of sorts has cropped up in liberal circles that I like to call “Would an Impeachment Even Be Worth It?” With the full acknowledgment that it’s unlikely to happen as long as Republicans are in charge, participants still sip cocktails and ponder out loud the question of whether booting out Trump on his butt would be enough to save our democracy, considering the fact that the Republican slimeball taking his place would invariably sign a bunch of retrograde legislation setting back this country decades.

These discussions break down into two camps: those who think Trump presents a unique threat to our democracy and replacing him with someone in the succession line, like Vice President Mike Pence or House Speaker Paul Ryan, would at least preserve our democratic norms; and those who think the corruption started long before Trump and has spread throughout the Republican Party, rotting it from the inside out.

Consider me in the latter camp, which makes me kind of unpopular in these discussions. Unfortunately, my view that the Republican Party as a whole is irredeemably antidemocratic has been borne out, yet again, in the process that Senate Majority Leader Mitch McConnell has put into motion to destroy the Affordable Health Act, a process that will likely take out the U.S. health care system as we know it.

One could even argue that bog-standard Republicans, under the leadership of Ryan and McConnell, represent an bigger threat to our democracy than Trump, possessing as they do more competence and cunning than the TV-addled overgrown toddler in the White House.

As Heather Digby Parton, writing for Salon, recently detailed, McConnell has arranged to have the Senate version of the House’s American Health Care Act (which the Congressional Budget Office estimates would ultimately leave 23 million Americans uninsured) written in secret, with no hearings, no public discussion and no real debate. Republicans are barely even pretending the reason is anything other than the obvious: The bill is so terrible that it defies the will of people of all political stripes and sensibilities, whom legislators supposedly were elected to serve. When called out on this obvious fact, Republicans are just smirking or squawking “fake news” but not actually offering any contravening evidence.

McConnell’s contempt for the processes, much less the defining principles, of democracy couldn’t be more apparent. But he doesn’t really care. No doubt the election of Trump helped confirm the rising sense among Republicans that they can wipe their collective butts with the Constitution, flip the bird at their constituents and not really worry about losing many seats. Republican voters might not like it, but they like liberals, black people and feminists even less, so they will show up and dutifully vote against the Democrats every time. Losing health care access isn’t great, but for conservative voters, admitting that liberals might have a point is a hell from which there is no escape.

This Republican contempt for democracy was evident long before Trump started grasping for the presidential nomination with his stubby orange fingers. McConnell was so unwilling to accept the legitimacy of Barack Obama’s two substantial presidential election victories that the Republican leader refused to acknowledge Obama’s right to nominate a Supreme Court justice after Antonin Scalia’s death. Not only did that work out perfectly for McConnell — he got Neil Gorsuch onto the high court, instead of rightful nominee Merrick Garland — but it proved once and for all that bedrock conservative voters don’t care about niceties like the rule of law or government by the people. They just want to punish women for having sex and gripe about “Obama phones,” and don’t care if the price paid is the ultimate ruin of this country.

Trump didn’t make Republicans corrupt. They were already there. That’s why he hasn’t really needed to do any arm-twisting or commit blackmail, no matter how much he’d like to, in order to get a GOP-controlled Congress willing to look the other way when presented with a growing pile of evidence that something weird is going on with Trump and the Russians.

It’s easier to not care if Russian intelligence is actively seeking to subvert U.S. elections for those who aggressively try to deny voting rights to millions of Americans, especially people of color and younger voters who insist on voting for Democrats.

At this point, the Republican rejection of democracy is an established fact. The only question is how far the ruling party is willing to take it. The antidemocratic, secretive process surrounding the GOP’s health care bill suggests there may be no real limit.

 

Amanda Marcotte is a politics writer for Salon. She’s on Twitter @AmandaMarcotte

Senate Republican health plan could make deeper cuts to Medicaid than House version

By Kate Randall
20 June 2017

As the Senate Republican “working group” continues to craft its plan to “repeal and replace” the Affordable Care Act (ACA) behind closed doors, press reports suggest that in some respects the Senate bill will go even further than the House version in attacking working people and cutting health care for low income families.

Both the Senate bill and the American Health Care Act (ACHA) passed by the House would gut Medicaid, the health insurance program jointly administered by the federal government and the states. The Congressional Budget Office (CBO) has estimated that the AHCA would cause 23 million people to lose health insurance by 2026, mainly because the House bill would effectively end the ACA’s Medicaid expansion for low-income adults.

The AHCA would cut $800 billion from Medicaid over 10 years, by both ending the expansion of the program and placing a per capita cap on Medicaid spending overall. This would mark the end of the program as a guaranteed social benefit based on need, forcing states to cut back benefits and throw people off the rolls.

The Hill, citing lobbyists and Senate aides, now reports that an option being considered by the 13-member Senate working group would make even deeper cuts to Medicaid by changing the way growth in per-patient spending is calculated. While the proposal would start with the growth rate for the cap on Medicaid spending at the same levels as the House bill, beginning in 2025 it would drop it to a lower growth rate, the Hill’s sources say.

The AHCA would cap Medicaid’s per-patient spending and adjust it upward each year based on the CPI-M, the consumer price index for urban consumer medical care. It would add an extra percentage point each year for spending for the elderly and disabled. The Senate plan would use the same system initially, but beginning in 2025 it would adjust per-enrollee spending using the standard CPI-U, or prices paid by urban consumers for a representative basket of goods and services.

The change is not simply one of bookkeeping. Due to the rising cost of medical care relative to other consumer goods, the change would cripple Medicaid even further by decreasing the already restrictive spending cap and growth rate. To put this into perspective, since 2000, the CPI-M has grown about 41 percentage points more than the CPI-U.

According to the Hill, the “plan has been described as a ‘consensus option’” and has already been sent to the Congressional Budget Office for analysis. The Office of the Chief Actuary at the Centers for Medicare and Medicaid Services (CMS) recently estimated that the change in the consumer price index used would slash an estimated $64 billion from Medicaid funding over a decade.

While Senate Republicans are in the final stages of drafting the bill, without any public hearings or even a pretense of consultation, Senate Democrats are engaged in a political stunt that will do nothing to stop passage of the reactionary legislation.

The Democrats planned to disrupt Senate business by holding the floor all Monday night to protest the Republicans’ secretive proceduring, using parliamentary tactics to disrupt the ordinary business of the chamber.

While making speeches on the virtues of Obamacare—the Democratic program to cut health care costs for corporations and the government—the Democrats are making only a token gesture against the even more reactionary pro-business replacement plan being drafted by the Republicans.

The Democrats can offer no way forward for the millions of Americans who are currently struggling to obtain health care and pay their bills under Obamacare, and will fare even worse under the Republican replacement. That is because the Democrats share the same class objectives as the Republicans, to boost the profits of insurance companies, drug companies, hospital chains and medical device companies.

Senate Majority Leader Mitch McConnell has set a goal of pushing the legislation through before the July 4 recess, using the process known as “reconciliation,” which allows the bill to pass with a simple majority and exempts it from any filibuster. The main obstacle to passage is not any protest by the Democrats, which is only for public consumption, but differences within the Republican caucus in the Senate and between House and Senate Republicans.

Meanwhile, a new study also shows the potential ill effects of the House bill, the AHCA, on the US economy. The study by the Commonwealth Fund and George Washington University shows that while the economy would see a short-term boost from the repeal of the ACA’s taxes on the wealthy and corporations, in the long run the decrease in federal spending on health care would lead to the loss of almost 1 million jobs over a decade.

Credit: Business Insider • Source: The Commonwealth Fund

The study writes of the AHCA: “It initially raises the federal deficit when taxes are repealed, leading to 864,000 more jobs in 2018. In later years, reductions in support for health insurance cause negative economic effects. By 2026, 924,000 jobs would be lost, gross state products would be $93 billion lower, and business output would be $148 billion less. About three-quarters of jobs lost (725,000) would be in the health care sector.”

The number of people working in the health care sector has risen in recent years due to the greater access to health care by people newly insured under Obamacare or through the expansion of Medicaid, as well as the aging of the population. The study notes that under the AHCA, cuts to Medicaid and federal subsidies for people to access health insurance would lead to fewer people using medical care and fewer jobs in the health care sector.

In other words, the estimated 1 million job losses would be a direct result of people being denied access to needed medical care, and those who are insured would have less money to put back into the economy in the form of consumer spending. The job losses would vary by state, according to the study, with many losing tens of thousands of jobs (see map).

http://www.wsws.org/en/articles/2017/06/20/heal-j20.html

The Surprising Cross-Partisan Appeal of Single-Payer Healthcare

Where Trump voters and socialists agree.

BY THEO ANDERSON

“It’s not difficult to talk about healthcare with people from across the spectrum. People want to pit rural Trump voters against the educated, progressive people in the cities, and that’s not where the tension is.”

In early April, a public radio program in the Rust Belt city of Rochester, N.Y., spent an hour discussing healthcare—but not, as you might expect, the GOP’s attempt to repeal and replace Obamacare. It focused instead on the brightening prospects for a single-payer healthcare system. The guests included a Trump voter and small-business owner, Tim Schiefen, and the co-chair of the Rochester chapter of the Democratic Socialists of America (DSA), Karen Vitale. What was remarkable was how little they disagreed.

Asked his opinion of single-payer, Schiefen responded that it was worth exploring. “The problem is putting the foxes in charge of the henhouse,” he said. “Why are we allowing these gross, overspending health insurance companies … to administer this stuff?”

Increasingly, the single-payer solution is generating that sort of consensus across ideological and party affiliations. In early April, an Economist/ YouGov poll showed that 60 percent of respondents supported a “Medicare for all” system, including 43 percent of people who identified as conservative and 40 percent of Trump voters.

The energy behind single payer is partly a result of the GOP’s success in pointing out the flaws in Obamacare, then failing to offer a workable alternative. Vitale believes that, in a paradoxical way, it’s also driven by Trump.

“I think Trump broke open a lot of things,” says Vitale, who grew up in a rural small town an hour south of Rochester. She says that the Trump voters she knows trusted his populist pitch— and “now they’re activated, and they’re acting from a place of self-interest. You can’t put them back in the box.” When Trump breaks campaign promises, she predicts, “They’re going to notice really quickly. They noticed with Trumpcare.”

That doesn’t mean they’re ready to abandon Trump. On the radio program, Schiefen said he appreciates Trump’s “moxie” and has no regrets. But he also said he would be willing to vote for Democrats with better ideas. “The whole system is built too much on us [versus] them,” he said. “Let’s put aside the differences. Let’s get to the root of the concern.”

A healthy interest

Vitale and other members of the Rochester DSA are part of a coalition pushing for single-payer reform in New York State. In early April, they traveled to Albany to lobby state legislators. They also regularly canvass the city, educating people about single payer and urging them to call their representatives.

“It’s not difficult to talk about healthcare with people from across the spectrum,” Vitale says. “People want to pit rural Trump voters against the educated, progressive people in the cities, and that’s not where the tension is. The tension is with suburban Trump voters who are wealthy and doing very well in our current healthcare system, and have no interest in reform.”

The power of single payer as an organizing tool seems to hold true across the nation. As with many DSA chapters, the East Bay DSA has seen a spike in membership since the election, and much of the new energy is being channeled into the push for single payer. The chapter sends hundreds of volunteers each month to canvass on behalf of the Healthy California Act, which would create a state single-payer system.

“It’s strategic because it’s something that’s going to profoundly benefit the vast majority of people,” says Ari Marcantonio, East Bay DSA’s lead organizer for the campaign. “So this is an issue we can mobilize tens of millions around. But single mothers, people of color, poor people and immigrants will benefit the most. ”

Among some conservatives, the shift in thinking on healthcare is being driven by the idea that, as Schiefen said, the insurance companies are profiting at the expense of people’s health. That critique allows them to pin the problems on Obamacare while embracing the idea of universal healthcare.

Consider Christopher Ruddy, a Trump supporter and CEO of the influential conservative website Newsmax. In a recent editorial, he urged Trump to “reject the phony private health insurance market as the panacea” and lamented that Paul Ryan’s second plan “accepts key parts of the Obamacare law that benefit the insurance industry, but it ends the Medicaid expansion program that benefits the poor and keeps costs down.”

Ruddy didn’t embrace a full single-payer system. But he did argue that Trump should honor his campaign pledge to provide universal healthcare. It could be achieved, he wrote, by expanding the Medicaid system “to become the country’s blanket insurer for the uninsured.”

When a dramatic expansion of the Medicaid program is a prominent conservative’s solution to our healthcare crisis, we’ve entered uncharted waters.

A bigger boat

As recently as last year, the push for a single-payer system seemed virtually dead among the Democratic establishment. Hillary Clinton ran on the promise of tweaking Obamacare. The liberal economist Paul Krugman wrote that Bernie Sanders’ “Medicare for all” proposal was “just not going to happen anytime soon.”

Now, the goal seems a lot closer. In January, Rep. John Conyers (D-Mich.) reintroduced a bill—originally put forth in 2003—that would create a publicly financed universal healthcare system funded largely by a payroll tax, tax hikes on the rich and a financial transactions tax. Conyers’ bill, The Expanded and Improved Medicare for All Act, has widespread backing from unions, medical organizations and progressive groups, and had 104 co-sponsors as of late April.

Bernie Sanders has promised to introduce a single-payer bill in the Senate, leading CNN to predict that “Democrats eyeing the 2020 presidential contest could soon face a ‘Medicare-for-all’ litmus test from the party’s progressive base.” At a rally in March, Sanders said, “Every major country on earth guarantees healthcare to all people … don’t tell me that in the United States of America, we cannot do that.”

This abrupt turnabout is partly a result of the Republican failure to replace Obamacare. The GOP’s flailing has energized and focused the resistance to Trumpism while undermining the party’s legitimacy on the issue. The videos and headlines from raucous town halls have been particularly devastating. A Pew Research poll released in mid-April found a 19-point gap regarding which party is trustworthy on healthcare, with 54 percent saying that Democrats would do a better job.

At the same time, progressive energy has expanded the horizon of possibilities. Groups devoted to pushing the Democratic Party in a progressive direction—like Justice Democrats, Brand New Congress and Progressive Change Campaign Committee (PCCC)—are making healthcare reform central to their work, and they’ve moved well beyond Obamacare. Brand New Congress, which recruits and supports progressive candidates for office, cites “making Medicare available to anyone who wants it” among its highest priorities. PCCC has collected more than 40,000 signatures on a petition that asserts, “All Democrats running for office in 2018 should publicly support and run on passing Medicare for All.” The goal is “to create a push for Democrats to go bold,” says Kaitlin Sweeney of PCCC.

These federal reform initiatives are working in synergy with state-level proposals. In Minnesota, state Sen. John Marty introduced legislation in January to create a single-payer system with universal coverage. More than 250,000 Minnesotans are currently uninsured.

“The Affordable Care Act was a half-baked solution,” says Marty, a member of the Democratic Farmer Labor Party. “I don’t want to minimize for a minute the difference it makes. It covered many millions more people. But … the system is dysfunctional, and it’s getting worse.”

Drop by drop

Marty compares the healthcare fight with the struggle for marriage equality, in which state laws created a domino effect. In 2008, he introduced a marriage equality bill in the Minnesota Senate and said it could pass in five years—which it did, in 2013. “This is doable stuff,” he says. “Times are changing and [single payer] could happen.”

None of the state-level campaigns are a sure thing. The November election turned the Minnesota legislature considerably “redder,” meaning Marty’s bill has no chance in the near term. The Healthy California Act, introduced in February, appears to have broad support in the legislature, but Democratic Gov. Jerry Brown has been skeptical. In New York, single-payer legislation is stuck in the GOP-controlled Senate.

But if and when one state adopts a single-payer system, it could quickly alter the national political landscape, with implications far beyond the fight for healthcare reform. For DSA, the fight for single payer is intended to be the first stage of a revolutionary program.

“The single-payer campaign is really about training hundreds of young people who have never been involved in activism or politics to get brass tacks organizing skills, which are door-todoor outreach,” says Ari Marcantonio of East Bay DSA. “We’re using it to build a mass socialist organization, city by city, and the power and the infrastructure we need to win all kinds of things—like a living wage for all workers and housing as a human right.”

Fundamentally, he says, the aim is to “challenge the very deeply ingrained notion that markets are our friend.”

THEO ANDERSON

Theo Anderson, an In These Times writing fellow, has contributed to the magazine since 2010. He has a Ph.D. in modern U.S. history from Yale and writes on the intellectual and religious history of conservatism and progressivism in the United States. Follow him on Twitter @Theoanderson7 and contact him at theo@inthesetimes.com.

http://inthesetimes.com/article/20121/where-trump-voters-and-socialists-agree-single-payer

Moore: Medicaid cuts were “central to our plan all along,” contrary to Trump’s public statements

CNN’s Stephen Moore accidentally confirms Trump was lying about commitment to protect Medicaid

CNN’s Stephen Moore accidentally confirms Trump was lying about commitment to protect Medicaid
(Credit: AP Photo/Evan Vucci)

This post originally appeared on Media Matters.

Discredited right-wing economic pundit and former Trump campaign economic adviser Stephen Moore accidentally let slip that gutting the Medicaid program “was central” to President Donald Trump’s plan to repeal Obamacare, despite the president’s repeated assertions that he would not touch the program. The statement corroborates admissions Moore made at a private event last July, when he claimed that Trump would fund massive tax cuts and reckless spending by dismantling programs that provide basic living standards for millions of Americans.

During the May 8 edition of CNN Newsroom, Moore — CNN’s “senior economics analyst” — was joined by University of Chicago economist Austan Goolsbee to discuss the merits of billionaire businessman and philanthropist Warren Buffett’s argument that the Trump health care agenda amounts to little more than a tax cut for the rich funded by cuts to health care subsidies for low-income Americans. Goolsbee pointed out that Trump’s health care legislation “cuts taxes for high-income people by hundreds of billions of dollars” at the expense of Medicare and Medicaid, which Trump promised “he would never cut.” Moore interjected falsely: “He never said that we weren’t going to reform Medicaid,” arguing, “That was central to our plan all along.”

Moore’s claim was debunked on air by co-hosts John Berman and Poppy Harlow, as well as Goolsbee, who cited Trump’s tweets and public statements as proof that he had broken his promise to protect Medicaid. Reporters who tuned in for the performance also noted Moore’s false statement. Moore accepted Berman’s correction before quickly pivoting to talking points extolling the virtues of converting Medicaid to block grants, which would also amount to a massive benefit cut for recipients.

Moore’s secondary claim that gutting Medicaid was “central to our plan all along” drew little notice from the fact-checkers, but it sheds light on Trump’s real agenda. According to a September 7 article from HuffPost political reporter Christina Wilkie, Moore had outlined Trump’s often contradictory economic plans during a “question-and-answer session” at a private July 14 meeting of the conservative Council for National Policy (CNP) in Cleveland, OH. During the event, Moore suggested that Trump planned to pay for his costly economic agendaby removing supposedly onerous public protections imposed by the federal government and enacting “draconian public assistance reforms and cuts in social services.” Since taking office, Trump has proposed a budget and health care agenda that would fulfill those promises. As the article noted, Moore’s zeal for tearing down anti-poverty programs, including Medicaid, seems to undermine Trump’s claim that he would focus on “looking out for the downtrodden.” It also confirms that imposing this harsh agenda — and lying about it — was indeed “central to” the Trump team’s economic plan “all along.”

 

http://www.salon.com/2017/05/13/cnns-stephen-moore-accidentally-confirms-trump-was-lying-about-commitment-to-protect-medicaid_partner/?source=newsletter

Trumpcare Is a Transfer From the Sick and Poor to the Rich and Healthy

Posted on May 7, 2017

By Robert Reich / RobertReich.org

John Flores / CC BY-SA 2.0

Shame on every one of the 217 Republicans who voted to repeal the Affordable Care Act on Thursday, and substitute basically nothing.

Trumpcare isn’t a replacement of the Affordable Care Act. It’s a transfer from the sick and poor to the rich and healthy.

The losers are up to 24 million Americans who under the Affordable Care Act get subsidies to afford health insurance coverage, including millions of people with pre-existing conditions and poor people who had access to Medicaid who may not be able to afford insurance in the future.

The winners are wealthy Americans who will now get a tax cut because they won’t have to pay to fund the Affordable Care Act, and healthy people who won’t have to buy health insurance to subsidize the sick.

House Republicans say they have protected people with pre-existing health problems. Baloney. Sick people could be charged premiums so high as to make insurance unaffordable. Trumpcare would even let states waive the Obamacare ban on charging higher premiums for women who have been raped — which actually occurred before the Affordable Care Act.America has the only healthcare system in the world designed to avoid sick people. Private for-profit health insurers do whatever they can to insure groups of healthy people, because that’s where the profits are. They also make every effort to avoid sick people, because that’s where the costs are.

The Affordable Care Act puts healthy and sick people into the same insurance pool. But under the Republican bill that passed the House, healthy people will no longer be subsidizing sick people.  Healthy people will be in their own insurance pool. Sick people will be grouped with other sick people in their own high-risk pool – which will result in such high premiums, co-payments, and deductibles that many if not most won’t be able to afford.

Republicans say their bill creates a pool of money that will pay insurance companies to cover the higher costs of insuring sick people. Wrong. Insurers will take the money and still charge sick people much higher premiums. Or avoid sick people altogether.

The only better alternative to the Affordable Care Act is a single-payer system, such as Medicare for all, which would put all Americans into the same giant insurance pool. Not only would this be fairer, but it would also be far more efficient, because money wouldn’t be spent marketing and advertising to attract healthy people and avoid sick people.

Paul Ryan says the House vote was about fulfilling a promise the GOP made to American voters. But those voters have been lied to from the start about the Affordable Care Act. For years Republicans told them that the Act couldn’t work, would bankrupt America, and result in millions losing the healthcare they had before. All of these lies have been proven wrong.

Now Republicans say the Act is unsustainable because premiums are rising and insurers are pulling out. Wrong again. Whatever is wrong with the Affordable Care Act could be easily fixed, but Republicans have refused to do the fixing. Insurers have been pulling out because of the uncertainty Republicans have created.

The reason Republicans are so intent on repealing the Affordable Care Act is they want to give a giant tax cut to the rich who’d no longer have to pay the tab.

Here we come to the heart of the matter.

If patriotism means anything, it means sacrificing for the common good, participating in the public good. Childless Americans pay taxes for schools so children are educated. Americans who live close to their work pay taxes for roads and bridges so those who live farther away can get to work. Americans with secure jobs pay into unemployment insurance so those who lose their jobs have some income until they find another.

And under the Affordable Care Act, healthier and wealthier Americans pay a bit more so sicker and poorer Americans don’t die.

Trump and House Republicans aren’t patriots. They don’t believe in sacrificing for the common good. They don’t think we’re citizens with obligations to one another. To them, we’re just individual consumers who deserve the best deal we can get for ourselves. It’s all about the art of the deal.

So what do we do now? We fight.

To become law, Trumpcare has to go through 4 additional steps: First, a version must be enacted in the Senate. It must then go a “conference“ to hammer out differences between the House and Senate. The conference agreement must then pass in the House again, and again in the Senate.

I hope you’ll be there every step of the way, until Trumpcare collapses under the weight of its own cruelty. House Republicans who voted for this travesty will rue the day they did. Any Senate Republican who joins them will regret it as well.

http://www.truthdig.com/report/item/trumpcare_is_a_transfer_from_sick_poor_to_the_rich_and_healthy_20170507

The Republican Party is sociopathic: If you didn’t know that already, the health care bill should make it clear

Republicans have long since left normal politics behind and veered into irresponsible, sadistic misbehavior

The Republican Party is sociopathic: If you didn't know that already, the health care bill should make it clear
Paul Ryan; Donald Trump; Kevin McCarthy (Credit: AP/Getty/Salon)

On Thursday, Republicans in the House of Representatives voted to repeal the Affordable Care Act in order to give the richest Americans and corporations billions of dollars. To accomplish this, Republicans will deny tens of millions of Americans who have chronic and preexisting health problems access to affordable medical care. The Republican Party’s plan to punish the sick and to kill the “useless eaters” has expanded its targets to include women who have been victims of sexual assault or domestic violence or suffered from post-partum depression. The Republican plan will also hurt disabled people, senior citizens, new mothers, pregnant women, children in special education programs and babies. It is estimated that at least 43,000 Americans a year will die if the Affordable Care Act is repealed.

This is quite literally the politics of life and death. Republicans in Congress have chosen to place their fingers on the scale in favor of the latter.

After finding “courage” prior to their vote from watching the movie “Rocky” and supposedly drawing inspiration from Gen. George Patton, these Republicans — a group largely comprised of rich, old white men — basked in the glow of their “success” while they drank beer and took photos with President Donald Trump in the Rose Garden. In all, it was a macabre and perverse bacchanal of plutocratic greed and civic irresponsibility.

The Republican Party is sociopathic: If you didn’t know that already, the health care bill should make it clear

The vote to repeal the Affordable Care Act was also a reminder of two very frightening and disturbing truths that most of the mainstream corporate news media will ignore.

Conservatives lack empathy for their fellow human beings. The Republican Party’s hostility to the poor, the working class, the elderly, immigrants, Muslims, refugees, the homeless, the vulnerable, gays and lesbians, children, people of color — and yes, the sick — is not an aberration or deviation from their voters’ basic desires. For those not of the right-wing tribe, a decision to strip away health care from millions of people does not make rational political sense. But for those inside the right-wing echo chamber, such a decision speaks to basic psychological and social impulses: It reinforces the demarcations separating “us” and “them,” the deserving and the undeserving, the righteous and the sinful.

In 2010, Ravi Iyer examined data that demonstrated the divergent role of empathy for conservatives and liberals. He observed:

The more interested in politics a conservative is, the lower his (or her) level of empathy. Liberals move in the opposite direction: the more interested in politics they are, the more empathetic. … In the 2010 election, 42 percent of voters identified themselves as conservative; 38 percent said they were moderate; and 20 percent said they were liberal. If that division obtains in 2012 and beyond, the proportion of conservative to liberal voters in the electorate should give liberals pause, especially insofar as they expect elected officials to propose and pass legislation the underlying purpose of which is to help those most in need.

Iyer’s observations would prove prophetic. In the 2016 presidential election, the empathy divide motivated millions of white conservatives and right-leaning independents to support Donald Trump: The opportunity to punish the Other paid a psychological wage, even if Trump’s actual policies would economically hurt the “white working class” voters who installed him in the White House — with the help of Russian President Vladimir Putin.

The Republican Party is sociopathic. As detailed by the International Statistical Classification of Diseases and Related Health Problems, exhibiting three or more of the following traits is sufficient for the diagnosis of sociopathy:

  • Callous unconcern for the feelings of others
  • Gross and persistent attitude of irresponsibility and disregard for social norms and obligations
  • Incapacity to maintain enduring relationships, though having no difficulty in establishing them
  • Very low tolerance to frustration, a low threshold for discharge of aggression, including violence
  • Incapacity to experience guilt or to profit from experience, particularly punishment
  • Markedly prone to blame others or to offer plausible rationalization for the behavior that has brought the person into conflict with society

The Diagnostic and Statistical Manual of Mental Disorders adds these two qualifiers:

  • Deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure
  • Impulsiveness or failure to plan ahead

The Republican Party’s policies on health care, the economy, the social safety net, law enforcement and racial issues, and its attitudes toward women, gays and lesbians, and other vulnerable and marginalized groups fit many of these criteria. In their reactionary, revanchist and destructive approach to political community and the commons, modern American conservatives in general also exhibit many sociopathic traits.

Organizations and communities elevate to positions of power those individuals who best embody their values. So it is no coincidence that the Republican Party’s current leader, Donald Trump, exemplifies many of the traits common to sociopaths.

A lack of empathy and an embrace of sociopathy has helped to make the Republican Party in its current form largely exempt from the rules governing “normal politics.” The Republican Party now represents a form of right-wing politics that has more in common with extreme religious fundamentalism than it does with post-Enlightenment rationality. In combination with a compliant American news media, gerrymandering, voter suppression, a highly effective propaganda machine, manipulation of the rules governing procedures in the House and the Senate, and a large conservative base that has been conditioned toward compliance, lies and authoritarianism, the Republican Party will likely maintain control of the United States on a local and state level for the foreseeable future.

The pundit and chattering classes want to believe that the “adults” in the U.S. Senate will stop Donald Trump and the Republican Party’s latest effort to destroy the Affordable Care Act. They also think that Trump’s voters will turn on him once his policies begin to negatively impact them in material and tangible ways.

These so-called experts have little to no credibility: They are the same people who believed that Trump would never be elected president. These supposedly astute observers of the American scene misunderstand this cultural moment because they presume reason and human decency where there is only madness, greed, bigotry, rage, racism, sexism and nihilism. To acknowledge these matters is not to surrender to them. It is necessary, if good and decent human beings who believe in the best of America are to equip themselves to fight back and win.

Chauncey DeVega is a politics staff writer for Salon. His essays can also be found at Chaunceydevega.com. He also hosts a weekly podcast, The Chauncey DeVega Show. Chauncey can be followed on Twitter and Facebook.