What will happen to Trumpcare? Leave it for the vultures
House Speaker Paul Ryan has introduced a real vulture of a bill to replace Obamacare.
I was going to say “turkey” of a bill, but that’s not fair to turkeys, which many of us enjoy at Thanksgiving. This bill is more like a scavenger that wants to loom over and starve the Affordable Care Act and the millions of people it helps, and then feed off the carcass. Yes, vultures are a necessary part of the ecosystem, especially when they rid the environment of otherwise putrid meat, digesting it with the corrosive acid in their stomachs. But they’re totally un-necessary in the workings of government and the nation’s health care system.
Republicans have been trying to repeal the Affordable Care Act ever since they regained the majority in Congress. They hyped the “repeal” part without bothering with the “replace” part. Well, they finally came up with a replacement that has earned more derogatory names than Donald Trump gave to his primary opponents.
Many hard-core conservative are calling it “Obamacare Lite” or “Obamacare 2.0.” New York Times columnist Paul Krugman calls it “Obamacare 0.5.” #Trumpcare started trending on Twitter immediately. It’s also earned the monikers RyanCare and HellCare, and (courtesy of those on Daily Kos) TrumpDoesn’tCare, the Unaffordable Care Act, the American Health Carnage Act, and GOPCare, “to tar them all.” Democrats in the House proposed (unsuccessfully) to change the name of the bill to the “Republican Pay More For Less Care Act.” Many conservative pundits trashed it, including Ann Coulter, who tweeted, “Who wrote this piece of crap?”
Even Breitbart hated it, claiming that it “GIVES ILLEGAL ALIENS HEALTH CARE THROUGH IDENTITY FRAUD.” Well, Breitbart was never one to let facts stand in the way of an incendiary headline.
So what will be the ultimate fate of this bill that House Republicans are trying to ram through, even as they try to pre-emptively trash what is bound to be a bad score from the Congressional Budget Office once the numbers are crunched? A bill opposed by many health care organizations, including the American Medical Association, the American Hospital Association, the American Nurses Association, and specialty societies? A bill that even the health insurers’ trade group, America’s Health Insurance Plans, found objections to—even though those insurers get all kinds of windfalls? A bill derided from the right by conservatives like Sen. Rand Paul, the Koch brothers, the Club for Growth, and FreedomWorks? A bill whose changes in Medicaid have earned scorn from the other direction of at least four GOP senators, two of whose votes would be necessary for passage?
President Trump was noncommittal at first, but now he’s decided that it’s a “wonderful” bill and said he would work with conservative leaders in Congress to make sure it passed, launching what Rand Paul called a behind-the-scenes “charm offensive” (Trump=charm? Talk about an oxymoron). Because Trump is so good at working with others. And like he’s got any clue how passing legislation works. “The President simply has no appetite for the hard work of passing laws,” wrote Josh Marshall at Talking Points Memo.
He has defaulted to rolling out executive order after executive order, in most cases Potemkin decrees with vaguely legalistic language and limited actual impact. Like so much with Trump, it’s a mix of authoritarianism on the one hand and impatience and flimflam on the other. The upshot isn’t so much a poor man’s as a lazy man’s authoritarianism.
Yet Trump is threatening to unleash the dreaded Twitter finger of doom. He warned that Republicans who withhold support for the replacement bill would suffer badly in the 2018 midterm election, saying they would go down in an “electoral bloodbath” if they don’t follow through on their promises to get rid of Obamacare.
Sorry to point this out to the tweeter-in-chief and the GOP denizens on the Hill, but citizens all over the country have been lambasting their representatives (those who have deigned to actually hold town halls and meet with constituents, that is) about keeping the ACA. Tweak it and improve it, yes. Get rid of it completely and pass a half-assed piece of legislation that would limit care, remove people from the insurance rolls, and raise insurance costs (especially for older adults not yet of Medicare age)? No.
The bill would allow insurers to charge older Americans five times more than younger people for health insurance, but subsidies are limited and wouldn’t cover the extra cost. And if there’s anything those in Congress should have learned their lessons about, it’s “Don’t piss off older voters.”
You might remember the disastrous legislation Congress passed in 1988, the Medicare Catastrophic Coverage Act. The law actually provided coverage for some outpatient drugs and offered protection against “catastrophic” medical expenses under Medicare. But that extra coverage was funded by increased premiums and a supplemental premium tax on Medicare beneficiaries, and seniors groups quickly convinced beneficiaries that the costs outweighed the benefits.
There was a seniors’ revolt. House Ways and Means Chairman Dan Rostenkowski, who had led the fight for the bill, was chased by angry seniors back in his home district in Chicago. At one point they even jumped on the hood of his car, demanding to have their complaints heard.
The law was repealed the next year.
The AARP faced a lot of backlash in 1988 because they supported the Medicare catastrophic coverage bill. This time around, they’re asking their members to stand against the proposed GOP plan, calling the higher premiums an “age tax.” The AARP is trying to get #NoAgeTax trending. After all, a bill that allows for sky-high insurance premiums for older adults while offering a tax break for insurance executives making more than $500,000 a year isn’t going to play well.
There’s even been a suggestion that Ryan and his GOP cohorts might have an easier time passing it in the House if they know it will be nixed in the Senate, so they won’t have to pay a political price. Good luck with that strategy, guys!
My favorite faux argument about AHCA costs vs. coverage came from Rep. Jason Chaffetz. The Utah congressman earned a lot of deserved backlash when he said, “Maybe rather than getting that new iPhone that they just love and want to go spend hundreds of dollars on that, maybe they should invest in their own healthcare.” As if the cost of a smartphone would make up for what health care and insurance coverage costs over one year. Twitter had a field day making fun of Chaffetz. Forbes (hardly a bastion of liberalism) even developed a Chaffetz iPhone scale to see how many iPhones the typical American would have to give up to pay for health care.
8 iPhones: People on Medicare paying out of pocket for cancer treatment: up to about $8,000, beyond premiums.
12 iPhones: Premiums for private insurance for a family; annual: $12,000.
14 iPhones: Out-of-pocket maximum for a family plan before benefits kick in, this one on the Healthcare.gov exchange for 2017: $14,300.
60 iPhones: The estimated annual costs to provide therapies and other supports for an autistic child: $60,000.
Even worse, Chaffetz has no clue that many people with lower incomes use their smartphones as their computer—because they can’t afford the cost of a laptop or desktop and a monthly Internet fee. That smartphone is their electronic tie to the outside world. But since Chaffetz’ iPhone and his monthly Verizon Wireless bill might be paid for by his campaign donors, he doesn’t have to worry about such things.
Here’s an idea. Why don’t some Republicans in the Senate reach across the aisle to try to work with their Democratic counterparts to iron out some differences and come up with some solutions to improve the ACA? Republican Sens. Rob Portman (Ohio), Shelley Moore Capito (W.Va.), Cory Gardner (Colo.), and Lisa Murkowski (Alaska) all say they’ll oppose any plan that hurts lower-income Americans who were helped by Medicaid expansion. How about if they get on board with making Obamacare more efficient? There are plenty of ideas out there on how to do that, such as these from The New Yorker, or these ideas from the Harvard Business Review:
True health care reform will happen when care is redesigned around the patient, not the doctor or hospital; when the financial incentives reward better health outcomes rather than hospital beds filled; and when the consumer has access to information to make good choices.
Yeah, that won’t fly with Republicans. Many already are declaring the GOP health care bill DOA, so let’s just feed it to the vultures. Maybe the corrosive acid in the vultures’ stomachs will dissolve the damn thing once and for all.
Originally posted on Daily Kos March 12, 2017.