Monday, July 24, 2017

Health Care Is Still in Danger

Will Senate Republicans try to destroy health care under cover of a constitutional crisis? That’s a serious question, based in part on what happened in the House earlier this year.

As you may remember, back in March attempts to repeal and replace the Affordable Care Act seemed dead after the Congressional Budget Office released a devastating assessment, concluding that the House Republican bill would lead to 23 million more uninsured Americans. Faced with intense media scrutiny and an outpouring of public opposition, House leaders pulled their bill, and the debate seemed over.

But then media attention moved on to presidential tweets and other outrages — and with the spotlight off, House leaders bullied and bribed enough holdouts to narrowly pass a bill after all.

Could something similar happen in the Senate? A few days ago the Senate’s equally awful version of repeal and replace — which the C.B.O. says would leave an extra 22 million people uninsured — seemed dead. And media attention has visibly shifted off the subject, focusing on juicier topics like the Russia-Trump story.

This shift in focus is understandable. After all, there is growing evidence that members of the Trump inner circle did indeed collude with Russia during the election; meanwhile, Trump’s statements and tweets strongly suggest that he’s willing both to abuse his pardon power and to fire Robert Mueller, provoking a constitutional crisis, rather than allow investigation into this scandal to proceed.


But while these developments dominate the news, neither Mitch McConnell nor the White House have given up on their efforts to deprive millions of health care. In fact, on Saturday the tweeter-in-chief, once again breaking long-established rules of decorum, called on the audience at a military ceremony, the commissioning of a new aircraft carrier, to pressure the Senate to pass that bill.

This has many people I know worried that we may see a repeat of what happened in the spring: with the media spotlight shining elsewhere, the usual suspects may ram a horrible bill through. And the House would quickly pass whatever the Senate comes up with. So this is actually a moment of great risk.

One particular concern is that the latest round of falsehoods about health care, combined with the defamation of the C.B.O., may be gaining some political traction.

At this point the more or less official G.O.P. line is that the budget office — whose director, by the way, was picked by the Republicans themselves — can’t be trusted. (This attack provoked an open letter of protest signed by every former C.B.O. director, Republicans and Democrats alike.) In particular, the claim is that its prediction of huge losses in coverage is outlandish, and that to the extent that fewer people would be covered, it would be due to their voluntary choices.

In reality, those C.B.O. predictions of coverage losses are totally reasonable, given the Senate bill’s drastic cuts to Medicaid — 26 percent by 2026, and even deeper in the next decade. You have to wonder how someone like Senator Shelley Moore Capito of West Virginia could even consider supporting this bill, when 34 percent of her nonelderly constituents are on Medicaid. The same goes for Jeff Flake of Arizona, where the corresponding number is 29 percent.

And on those claims that it’s O.K. if people drop coverage, because that would be their own choice: It’s crucial to realize that the Senate bill would degrade the quality of subsidized private insurance, leading to a huge rise in deductibles.

Current law provides enough in subsidies that an individual with an income of $26,500 can afford a plan covering 70 percent of medical expenses, which, the C.B.O. estimates, implies an $800 deductible. The Senate bill reduces that standard of coverage to 58 percent, which would raise the implied deductible to $13,000, making the insurance effectively useless. Would deciding not to buy that useless insurance really be a “choice”?
By the way, remember when Republicans like Paul Ryan used to denounce Obamacare because the insurance policies it offered had high deductibles? It’s hypocrisy all the way down.

In short, the Senate bill is every bit as cruel and grotesque as its critics say. But we need to keep reminding wavering senators and their constituents of that fact, lest they be snowed by a blizzard of lies.


I’m not saying that everyone should ignore Trump-Putin-treason and all its ramifications: Clearly, the fate of our democracy is on the line. But we mustn’t let this mother of all scandals take up all our mental bandwidth: Health care for millions is also on the line.

And while ordinary citizens can’t yet do much about the looming constitutional crisis, their calls, letters, and protests can still make all the difference on health care. Don’t let the bad guys in the Senate do terrible things because you weren’t paying attention!




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