Republicans in Congress are using reliable tactics to achieve quick results on their various “health-care”* bills. That is, Republicans have avoided public scrutiny, misled, obfuscated, tossed around word salads, pointed fingers, and even lied – all in service of passing unpopular “health-care” legislation that is mostly a vehicle for tax cuts. Since they ran against Obamacare for the last eight years Republicans might as well follow through on their threats to destroy it, end Obamacare’s higher payroll taxes on high earners and other taxes, and then get on with income and corporate tax cuts.
(*I put “health-care” in quotes because the bill passed by the House and what we’ve heard about the Senate’s version so far are not really pieces of health-care legislation. They result in loss of coverage for over 20 million people and worse or less affordable coverage for millions more who had benefited from Obamacare. In addition, millions of Americans with employer-sponsored coverage will be worse off than they were in the pre-Obamacare status quo. Trumpcare dismantles government programs, regulations, and subsidies that make health insurance accessible, affordable, and useful to poor and working class Americans, all in the name of tax cuts for high earners and corporations. Really, a fairer way to describe what Republicans are up to is to say they are trying to offset tax cuts for the rich by stripping millions of poor and disabled Americans of their coverage and making insurance less affordable and useful to many other Americans. Some have referred to Republican plans as “wealthcare” but whatever we call it, the most important thing is to understand what it is.)
This is a good time to remind readers of a post I wrote describing a heuristic for understanding elected Republicans’ behavior. In “Why Trump Can Do Whatever He Wants,” I argued that the only way to make sense of their policy priorities is to realize that they are united in service of one goal: cutting taxes for the wealthiest. Why else are so many Republican members of the House and several senators marching to what many think is certain doom in their 2018 elections by taking health coverage away from their voters?
The answer is that you get elected to do stuff, even if that stuff may cost you your job. Republicans think they got elected to enact tax cuts financed by Obamacare repeal.
Back in 2009, Democrats thought they got elected in 2008 in part to make the health-care system work better for poor and working class Americans. They passed the Patient Protection and Affordable Care Act (ACA or Obamacare) and improved the system even though many of them knew Republicans would be able to demagogue the issue and beat them at the polls in 2010. Indeed, that came to pass and Democrats have been in the minority in the House since their 2010 wipeout. But some Democratic House members of the 111th Congress who lost their job consider their vote worth it. They got into office to make things work better for more American people. If the price of that decision was their seat in Congress, so it goes.
In a sense, that is what is going on with Republicans in Congress now. Except the constituency they are serving is not the poor and working class, but the highest 2% of American earners and corporate interests. This is an entirely reasonable thing to do. You get elected to do stuff, and most Republicans think they got elected to cut taxes on high earners and corporations. How they have been able to win elections while obscuring their overarching policy goal is interesting but beside the point. The fact is Republicans in Congress agree wholeheartedly on one main goal and want to achieve it. Funding that supports poor and working class Americans’ access to the health-care system stands in the way of tax cuts, so Republicans need to remove the obstacle.
Americans ought to debate these policy choices. But we kid ourselves and risk damage if we pretend these choices do not come with different sets of winners and losers. For example, one of the dumbest things any Democrat did during the ACA debate was when President Obama said people would be able to keep coverage and doctors they already had if they liked them. That line was meant to comfort a portion of the electorate that already had coverage and was nervous about potential negative effects of changes to the system. Unfortunately, as the ACA went into full effect some Americans had to find new carriers and provider networks, so Obama was either wrong or a liar. He and other Democrats avoided a full accounting of the ACA’s effects and one can argue they suffered accordingly at the ballot box.
Now, Republicans want to cut taxes for the wealthy, but they do not want to explain how that comes at the expense of the health of the poor and working class. What are they to do? Exactly what Republicans have been doing: rush legislation through with little analysis or public debate, and when challenged hedge or pretend the bills don’t do what they actually do.
For example, West Virginia’s Republican Senator Shelley Moore Capito is saying she does not look favorably on the Medicaid cuts rumored to be in the Senate’s bill. But in the end she’ll vote for the bill because that’s what she thinks she was sent to the Senate to do: free up money for tax cuts by repealing Obamacare. In the meantime, Capito will pretend she’s “concerned” and “worried” and “troubled” and “uncomfortable” about the Medicaid cuts to deflect from her true intentions. If she actually cared about the Medicaid cuts, after all, she’s free to debate the bill’s details in public and vote against the bill if she does not like the final product.
In the real world where policies have consequences, Capito and other “concerned” Republicans have two choices: 1) maintain or tweak coverage for poorer and lower income Americans and the taxes that finance it, or 2) cut hundreds of billions of dollars out of the system, kick millions of people out of the system, and use the savings for tax cuts. Capito and her fellow travelers insist on a third option: express concern about people losing coverage, vote to take away that coverage, and pretend cutting hundreds of billions of dollars out of the system won’t make anyone worse off, somehow (because freedom maybe). That’s just not how this works in the real world, but Republicans will dismantle Obamacare because of – not in spite of – this kind of dissembling. It works all the time in American politics.
I don’t know where all this goes in the medium term. In the short term, I’d bet Republicans succeed in gutting Obamacare but I hope I’m wrong. If I’m right, then Republicans up for election in 2018 and then 2020 will be running on their support for Trumpcare. Democrats say that removing hundreds of billions of dollars and important consumer protections from the system will have broadly negative consequences, including coverage loss for millions; Republicans say no it won’t, that citizens will once again have the freedom to not plan for an adverse health circumstance. We’ll see who’s right and whose interests are best served, and then we’ll see what voters think about it.
(But again, I’d rather Republicans not dismantle Obamacare. It’d be much better if they stopped sabotaging Obamacare and in fact made some tweaks to improve it. That’s very unlikely to happen, but I should make my preferences clear.)