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

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

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.

New research on why Republicans hate poor and sick people

The “pro-life” party has become the party of death:

New data and the health care debate reveal how Republicans feel about poor people who get sick: They deserve it

The "pro-life" party has become the party of death: New research on why Republicans hate poor and sick people
Trey Gowdy; Paul Ryan; Kevin McCarthy (Credit: AP/Susan Walsh/J. Scott Applewhite/Reuters/Gary Cameron)

On Thursday, Republicans in the House of Representatives will attempt to force through a health care “reform” bill that is likely to leave millions of Americans without health insurance, especially those who suffer from chronic illnesses such as cancer, diabetes and heart disease. It has been estimated that if the Republican Party is successful in eliminating the Affordable Care Act that at least 43,000 Americans a year will die from lack of adequate health care.

The Republican Party is pursuing this policy in order to give millions of dollars in tax cuts to the very rich. President Trump, who is a billionaire, would financially benefit if Republicans succeed in repealing the ACA.

It is abundantly clear that Trump and his party possess a deep disdain for sick people, the poor and other vulnerable members of American society and wish to do them harm.

For example, several days ago Rep. Mo Brooks, R-Ala., said this during an interview on CNN:

My understanding is that [the new proposal] will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool. That helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy. And right now, those are the people — who’ve done things the right way — that are seeing their costs skyrocketing.

These comments are abominable. Does Brooks believe that babies and children with serious illnesses deserve their fate, or that those who have “done the things to keep their bodies healthy” and still develop chronic diseases like cancer have done things the “wrong way”? The Republican Party’s war on the American people and the common good should be condemned by all decent human beings. Any Republicans who vote to repeal the Affordable Care Act should be publicly shamed and voted out of office.

But an important set of questions still remain: Why do Republicans and conservatives have such disdain for the weak, the vulnerable and the sick? Why do they want to kill the “useless eaters?” What does this tell us about how Republicans and conservatives view the world, as well as their relationships and obligations to other human beings?

A new survey from the Pew Research Center offered some helpful insights on these questions:

In assessing why some people are poor, 53% think it is because of circumstances beyond their control, while 34% attribute it to a lack of effort. There has been little change in these opinions in recent years, according to a survey in December.

By about three-to-one (66% to 21%), Republicans and Republican-leaning independents say hard work, rather than a person’s advantages, has more to do with why someone is rich. By nearly as wide a margin, Democrats and Democratic leaners say the opposite: 60% say a person is rich because they had more advantages than others, while just 29% say it is because they have worked harder.

As with many other issues, partisan differences in views of why people are rich and poor have increased in recent years. Since 2014, the share of Republicans who say a person is rich more because they have worked harder than others has risen 12 percentage points, from 54% to 66%. Democrats’ views have shown less change.

This survey from Pew continued:

Republicans are more likely to say the reason someone is poor generally has more to do with of a lack of effort (56%) than circumstances beyond a person’s control (32%). By 71%-19%, more Democrats say that circumstances beyond one’s control are generally more often to blame for why a person is poor. The share of Democrats who link a person being poor to a lack of effort has declined since 2014 (from 29% to 19%).

A belief in the “just world hypothesis” is a unifying theme in Pew’s findings: Republicans and conservatives are more likely to hold the erroneous belief that good things happen to good people and that individuals who suffer disadvantages in life that are out of their control are somehow responsible for their circumstances. The just world hypothesis is a fallacy.

In reality, people exist in a society where their life trajectories are largely determined by impersonal social and political systems. Nevertheless, the just world hypothesis can be compelling. It allows the privileged, the powerful and the rich to rationalize their opportunities: “I earned it! Those people are lazy!” “Good things happen to good people! Those people are immoral and made bad choices unlike me!” “Their problems aren’t my responsibility!”

Pew’s recent findings also demonstrate the enduring power of the Horatio Alger myth and the conception of meritocracy in America society.

The Horatio Alger myth — a belief that hard work and motivation determine success in America — had its origins in a series of dime-store novels written between 1860 and 1899. These absurd stories of success during the Gilded Age were derided and mocked even then by serious social reformers as well as luminaries such as Mark Twain.

The claim that America is a meritocracy, where talent and hard work are more important than good fortune or accidents of birth, goes far back into our history. It was also captured in a famous dystopian short story from 1958 by Michael Young, about a world in which people were constantly evaluated by tests and other means to ensure that the “best” people rose to the top. Of course, this supposed meritocracy was grossly unfair and unequal to the vast majority of citizens.

Social scientists have repeatedly demonstrated that American (and Western) society is extremely hierarchical and that family wealth and income — as well as race and gender — are more important than “hard work” in determining a given individual’s intergenerational class mobility.

Pew’s findings echo in the debate about health care policy, which reflects the belief among Republicans and conservatives that those who seek assistance from society have no right to receive it. If people do not have the resources to provide adequate health for themselves and their families, that’s their own fault. Most important, the sick deserve their illnesses; the healthy and strong have earned their advantages.

Once again, the repeated efforts by the Republican Party to repeal the minimal protections offered by the Affordable Care Act serve to remind us that conservatism is a type of socially motivated cognition that minimizes any sense of human obligation and connection to other people, outside a narrowly defined kin or other peer group.

Today’s version of American conservatism is also a celebration of selfishness — and a belief that true freedom and liberty are based on a perverse individualism with little sense of common decency or linked fate with someone’s fellow citizens. Today’s American conservatism also embraces an extreme form of neoliberalism whereby human worth and dignity are determined by profit-and-loss statements and capitalism and democracy are confused with one another. Ultimately, American conservatism is a value system that is antisocial, anti-democratic and anti-freedom.

There is a moral obligation to speak plainly and directly in a time of crisis. To wit: The Republican Party’s so-called health care reform is designed to kill, injure and bankrupt the poor, the sick and the weak, in order to line the pockets of the 1 percent. As Republicans have repeatedly shown, the supposed “party of life” is actually the “party of death.”

It is long overdue that the American people begin to use this more accurate language to describe the Republican Party, Donald Trump and the right-wing voters who support them. The debate about “repealing and replacing” the Affordable Care Act is not about normal political disagreement or budgetary priorities. It is about who should live and who should die and whether that should reflect how much money you have in your bank account.

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.

Donald Trump literally knows nothing: The moronic fiction of his “really, really good” health care plan is now obvious

Trump’s idiotic pronouncements on health care can’t conceal that he has no plan and doesn’t understand the details

Donald Trump literally knows nothing: The moronic fiction of his "really, really good" health care plan is now obvious
(Credit: Getty/Saul Loeb/Eduardo Munoz Alvarez/Photo montage by Salon)

President Donald Trump’s ridiculous plan to repeal and replace the Affordable Care Act would be slightly less disgusting if we were confident that he knew what the hell he was talking about. Throughout the past two years, though, it’s impossible to point to a single instance in which anyone, including Trump’s staff and supporters, could say that he totally nailed the nuances of the issue. Not once — ever.

Sure, he’s regularly claimed that the ACA is collapsing, contrary to the recent scoring by the Congressional Budget Office. He’s also mentioned that the ACA is a disaster. Same situation. He’s mentioned that under his replacement plan, everyone will have coverage that he or she loves and will save a lot of money in the process.

Oh, and he said something about keeping the ACA’s language about pre-existing conditions and “children living with their parents.” He noted the latter on a small, seldom-watched show called “60 Minutes,” despite the fact that there’s nothing in the law about covering kids who live with their parents. Yeah, it’s one of the top two most popular aspects of the ACA, and he couldn’t accurately describe it:   The law allows adult children to stay on their parents’ insurance until age 26 — regardless of where they live.

Perhaps Trump’s ignorance about the law is allowed to slide because his supporters know even less about the ACA than he does. Though it’s not just when Trump talks about the ACA that he sounds like an eighth-grader bluffing his way through an essay exam. That describes everything he says about health care in general. The president who chose health care reform as his big legislative goal in his first 100 days doesn’t know anything about how health care works.

As part of his effort to resurrect a major legislative crash and burn, what’s been nicknamed “Trumpcare,” the president fielded a question last week about the status of his negotiations with the House Freedom Caucus, the far-right hotheads largely identified with members of the Tea Party.

During a joint press conference with the president of Italy, Trump said, “The plan gets better and better and better, and it’s gotten really, really good. And a lot of people are liking it a lot. We have a good chance of getting it soon; I’d like to say next week, but it will be — I believe we will get it, and whether it’s next week or shortly thereafter.”

Words have no meaning for Trump.

“It’s gotten really, really good” isn’t the language of a man who’s familiar with the details. In fact, he can’t say anything specific about anything related to health care, for two reasons. First, he just doesn’t know. Generally, the ongoing rule about Donald Trump is that he knows nothing. Second, the details of Trumpcare, at least in terms of what’s being discussed partly in secret, totally undermine his promises for universal, affordable coverage. Discussing those details out loud would expose the game. Oh and incidentally, “gotten really, really good” might sound familiar because it’s the same awkward phrase Will Ferrell once used in a George W. Bush parody video back in 2004 (check the YouTube clip at 40 seconds in). In other words, at least until recently, describing how things have “gotten really, really good” was merely a joke at the expense of stupid people. Now the actual president talks like that. Hashtag Make America Great Again.

Nevertheless, if Trump were to actually tell us what’s in the latest version of Trumpcare, he might have to acknowledge that there’s no legislative text; there’s no actual bill yet. Nothing exists on paper. He’d also have to acknowledge that this new iteration won’t be more affordable and indeed that many more people will be kicked off their insurance policies under the new “really, really good” version of Trumpcare than would have lost insurance under the now-defunct American Health Care Act.

Donald Trump literally knows nothing: The moronic fiction of his “really, really good” health care plan is now obvious.

The Washington Post’s Eugene Robinson called Trumpcare 2.0 “comically bad.” But that language understates the awfulness of what’s being debated. Robinson reported last week that proponents of this new version are claiming it would protect essential health benefits (covering things like “hospitalization, maternity and emergency care” according to Robinson) and protect people with pre-existing conditions.

But here’s the catch. States will be able to opt out of covering essential health benefits. We can assume most red states will opt out, not unlike the way they opted out of the Medicaid expansion, for no other reason than they hate Obama. Smart. (By the way, the new version preserves the slow phaseout of the Medicaid expansion.) States can also opt out of the pre-existing conditions language as long as they create “high risk pools.” Of course this is totally unacceptable because Trumpcare 2.0 doesn’t prevent insurers from charging dramatically higher premiums for people with pre-existing conditions — basically rebuilding the pre-ACA system of gouging and usury against people who need health care the most.

Making matters worse, especially in the near term, it appears as though Trump is planning to use subsidy payments to customers with existing ACA marketplace policies as potential ransom in the forthcoming battle over a potential government shutdown. To put it another way, if the Democrats don’t agree to support appropriations to build Trump’s ridiculous border wall, Trump will withhold subsidies for literally millions of ACA customers. That means Trump haters in blue states and, yes, Trump fanboys in red states, too. Everyone living below 400 percent of the federal poverty level will lose their subsidies unless the Democrats vote for Trump’s pointless wall, which (not insignificant) was supposed to be financed by Mexico.

If both sides fail to agree, the government will be shut down as of Saturday. So Trump is basically saying, “Yeah, I promised Mexico will pay for the wall. But now that I’m reneging on a major platform plank like the weasel I am, I’m going to hold the lives of millions for ransom.” Yes, this is the bargaining position of the chief executive who pledged in his inaugural address to be the people’s president. America first, etc.

Really, really gotten good? You decide.

Again, we have no choice but to wonder whether Trump has even the slightest idea what’s at stake. Does he know how many of his red-blooded MAGA-hat wearing loyalists will lose their subsidies in this ludicrous cash grab for the border wall? Do his loyalists know? I doubt it. Does he even understand how and why the ACA subsidies are distributed? Does he realize how obvious it is that he’s entirely clueless about what will happen in a government shutdown or that his health care plan will lead to far worse outcomes than the current situation — even if the ACA marketplaces collapse, as he has predicted?

Does he know that the marketplaces are only a part of a more comprehensive pair of Obamacare-related bills containing critically important consumer protections, which are supported by majorities of Americans? No way. He knows none of it. It’s worth repeating this maxim because the more we internalize it, the more we embrace the horror, the better: Trump knows nothing.

 

Bob Cesca is a regular contributor to Salon.com. He’s also the host of “The Bob Cesca Show” podcast, and a weekly guest on both the “Stephanie Miller Show” and “Tell Me Everything with John Fugelsang.” Follow him on Facebook and Twitter.

Trumpcare, Ryancare, Trashcare: While the GOP celebrates its found money, the poor will get sicker and die

With the AHCA, the Republicans have put a price tag on the lives of America’s working class: $300 billion

Trumpcare, Ryancare, Trashcare: While the GOP celebrates its found money, the poor will get sicker and die
(Credit: AP/Susan Walsh)

Trumpcare, Ryancare, Trashcare — whatever you want to call it, the American Health Care Act is nothing more than a cheap stab at Barack Obama, a petty attempt on the part of grudge-holding Republicans, including President Donald Trump, to try to diminish Obama’s legacy. They can try, but that will be impossible — Trump’s follow-up act has been so bad so far that he’s making George W. Bush look practically Lincoln-esque. But let’s set legacies and agendas aside for now and focus on health care.

“We have come up with a solution that’s really, really, I think, very good,” Donald Trump has said. “It’s an unbelievably complex subject. Nobody knew that health care could be so complicated.”

I’m not a president or a billionaire. I could never afford the kind of routine checkups that Trump has access to from award-winning physicians with platinum stethoscopes and solid gold scalpels — or even a state-of-the-art Viking fridge stocked with spare teenage hearts and kidneys, all plump and ready to be inserted when Trump’s conk out. He’ll probably live to be 360 years old as a result. Most of us don’t have that experience, and the president, just like the congresspeople and senators who are aimlessly playing with the lives of their constituents by threatening to kill Obamacare, is taken care of. They have amazing health care coverage that we, the taxpayers, fund. Strangely, that never makes it into the conversation.

Is Obamacare perfect? Absolutely not. But it has already saved the lives of millions of people. People who would have never voted for Obama are calling him a hero, even as some die-hard right-wingers praise the Affordable Care Act for saving their loved ones, not realizing that it’s the same as Obamacare.

Trump loves his catchphrase, “Make America great again.” Obviously he doesn’t understand that “great” is a process that we must constantly work toward. Greatness is edited, nurtured and achieved after recognizing what works and what doesn’t. Scrapping Obamacare and replacing it with a trash plan that will leave millions of people who were born without the luxury of being Trump-level rich uninsured is not making anything great. It’s evil. According to the CBO analysis, the AHCA would “reduce federal deficits by $337 billion over the coming decade and increase the number of people who are uninsured by 24 million in 2026 relative to current law.” And every Republican is running to the cable news networks, bragging about saving $300 billion. What does that mean to the person the Wall Street Journal described, a 62-year-old person who makes $18,000 a year who will now face premiums of up to $20,000?

Imagine a sickly elderly woman running home from work to her family to share with pride that the government just saved $300 billion. There is nothing more important than that to the government, even if it means that you’re broke, your granddaughter is pregnant because she couldn’t get birth control, and your grandson overdosed and died because he couldn’t be treated for his prescription drug addiction, which he developed to self-medicate his depression over the factory jobs that Trump promised never coming. We should all celebrate because the government saved $300 billion? That’s $300 billion that regular people will never touch.

People will not be treated for their illnesses. Many will suffer, and some will die. But at least the GOP beat Obama!

D. Watkins is an Editor at Large for Salon. He is also a professor at the University of Baltimore and founder of the BMORE Writers Project. Watkins is the author of the New York Times best-sellers “The Beast Side: Living  (and Dying) While Black in America” and “The Cook Up: A Crack Rock Memoir.”