By Robert
Reich
The Senate’s bill to repeal the Affordable Care Act is not a healthcare bill. It’s a tax cut for the wealthiest Americans, paid for by a dramatic reduction in healthcare funding for approximately 23 million poor, disabled, and working middle class Americans.
America’s
wealthiest taxpayers (earning more than $200,000 a year, $250,000 for couples)
would get a tax cut totaling $346 billion over 10 years, representing what they
save from no longer financing healthcare for lower-income Americans.
That’s
not all. The bill would save an additional $400 billion on Medicaid, which
Mitch McConnell, Paul Ryan, and Donald Trump are intent on shrinking in order
to cut even more taxes for the wealthy and for big corporations.
If
enacted, it would be the largest single transfer of wealth to the rich from the
middle class and poor in American history.
This disgrace is being proposed at a time when the nation’s rich own a higher percentage of the nation’s wealth and receive the highest percent of America’s income since the era of the Robber Barons of the late nineteenth century.
Almost
all of the transfer is hidden inside a bill that’s supposed to be a kinder and
gentler version of its House counterpart, which Trump called “mean, mean,
mean.”
Look
closely and it’s even meaner.
The
Senate bill appears to retain the Affordable Care Act’s subsidies for poorer
Americans. But starting in 2020, the subsidies would no longer be available for
many of the working poor who now receive them, nor for anyone who’s not
eligible for Medicaid.
Another
illusion: The bill seems to keep the Affordable Care Act’s Medicaid expansion.
But the expansion is phased out, starting in 2021.
The
core of the bill – where its biggest savings come from – is a huge reduction in
Medicaid, America’s healthcare program for the poor, elderly, and disabled.
This,
too, is disguised. States would receive an amount of money per Medicaid
recipient that appears to grow as healthcare costs rise.
But
starting in 2025, the payments would be based on how fast costs rise in the
economy as a whole.
Yet
medical costs are rising faster than overall costs. They’ll almost
surely continue to do so – as America’s elderly population grows, and
as new medical devices, technologies, and drugs prolong life.
Which
means that after 2025, Medicaid coverage will shrink.
The
nonpartisan Urban Institute estimates that between 2025 and 2035, about $467
billion less will be spent on Medicaid than would be spent than if Medicaid
funding were to keep up with the expected rise in medical costs.
The
states would have to make up the difference, but many won’t want to or be able
to.
One
final major deception. Proponents of the bill say it would continue to protect
people with preexisting conditions. But the bill allows states to reduce
insurance coverage for everyone, including people with preexisting conditions.
So
insurance companies could technically “cover” people with preexisting
conditions for the cost of, say, their visits to a doctor, but not
hospitalization, drugs, or anything else they need.
The
Senate bill only seems like a kinder, gentler version of the House repeal of
the Affordable Care Act, but over time it would be even crueler.
Will
the American public find out? Not if McConnell can help it.
He
hasn’t scheduled a single hearing on the bill.
He’s
shut out major hospitals, physician groups, consumer advocates and
organizations representing millions of patients with heart disease, cancer,
diabetes, and other serious illnesses.
McConnell
thinks he’s found a quiet way not only to repeal the Affordable Care Act but
also to unravel Medicaid – and funnel the savings to the rich.
For
years, Republicans have been looking for ways to undermine America’s three core
social insurance programs – Medicaid, Medicare, and Social Security. The three
constitute the major legacy of the Democrats, of Franklin D. Roosevelt and
Lyndon Johnson. All continue to be immensely popular.
Barack
Obama’s Affordable Care Act is almost part of that legacy. It’s not on quite as
solid a footing as the others because it’s still new, and some wrinkles need to
be ironed out. But most Americans support it.
Now
McConnell believes he can begin to undo the legacy, starting with the
Affordable Care Act and, gradually, Medicaid.
But
he knows he has to do it in secret if he’s to be successful.
If
this shameful bill is enacted, McConnell and Trump – as well as every
Republican senator who signs on – will bear the burden of hundreds of thousands
of deaths that could have been avoided, were they not so determined to make
rich Americans even richer.
ROBERT B. REICH is Chancellor's Professor of
Public Policy at the University of California at Berkeley and Senior Fellow at
the Blum Center for Developing Economies. He served as Secretary of Labor in
the Clinton administration, for which Time Magazine named him one of the ten
most effective cabinet secretaries of the twentieth century. He has written
fourteen books, including the best sellers "Aftershock", "The
Work of Nations," and "Beyond Outrage," and, his most recent,
"Saving Capitalism." He is also a founding editor of the American
Prospect magazine, chairman of Common Cause, a member of the American Academy
of Arts and Sciences, and co-creator of the award-winning documentary,
INEQUALITY FOR ALL.