#TrumpRyanCare: ATM For The Wealthy

From the day the Affordable Care Act was passed and then signed into law by President Obama, Republicans have struggled to find adjectives and/or adjectival phrases sufficient to express their venomous disgust with and bombastic distaste for a law that extended health care insurance coverage to 17.1 million people between 2012, the year before the ACA was passed, and 2016--not only saving thousands of lives but improving the quality of life for millions of others in the process.

In reality, they didn't much care about the benefits it provided for millions of Americans, many of whom had not previously enjoyed access to either credible health care insurance or credible health care beyond what they could receive at the nearest ER--which, for many, had long been their PCP.

In reality, they didn't much care about the thousands of lives saved or the improved quality of life afforded to millions of Americans. Even the pleas of those whose lives were suchly saved or improved and the pleas of those who still depend on the ACA for life-sustaining treatment--movingly articulated to GOP legislators during often contentious town halls recently held by the few of them brave enough to face their own angry constituents--have not moved Republican legislators to rethink their positions as to getting rid of the ACA "root, stalk and branch."

Quite frankly, to sum it up, they don't give a damn about health insurance coverage for their constituents.

If they did, they would not have proposed an alternative health care plan which less resembles a health care plan than a tossed salad of Republican payoffs to the wealthiest among us and to those gleeful swamp critters whose food sources our Liar-in-Chief said he was going to cut off. They titled it the American Health Care Act. With all apologies to the poseur "policy-wonk" and poseur "public intellectual," Paul Ryan, I prefer to reference it as #TrumpRyanCare.

If they did, they would be paying attention to the fact that health care analysts such as Steven Brill and the health care economists at the Brookings Institute, health care foundations such as the Kaiser Family Foundation, economic analysts from such organizations as the Tax Policy Center and the Center for Budget Priorities, etc. support the findings of the non-partisan Congressional Budget Office that #TrumpRyanCare would result in 18 million people losing their coverage in its first year. And, in the year following the elimination of ACA tax subsidies and the Medicaid expansion, that number would balloon to 27 million. Jerry Brown, governor of California, has stated that #TrumpRyanCare, if passed, would negatively affect over six million people in California alone. Not to mention that the "plan" would also "devastate...state government budgets and public hospitals"--especially small hospitals in rural areas.

In fact, were Republicans to repeal the ACA and replace it with nothing, fewer people would be left uninsured than will be thusly left if #TrumpRyanCare or whatever you want to call this Christmas stocking for the wealthy is passed. Which led Bob Doherty, of the American College of Physicians, to tweet that "In 38 years advocating for doctors and patients, I've never seen a bill that will do more harm to health than #AHCA bill being voted on Thursday."

If they did, they would be paying attention to the fact that in only 80 of the country's 435 congressional districts is there more support for #TrumpRyanCare than the ACA. Indeed, upward of two-thirds of GOP House members represent districts that oppose the GOP plan more than the ACA--by rather healthy margins.

If they did, they would be paying attention to the fact that the well-respected Quinnipiac University poll released on March 23 found that #TrumpRyanCare was supported by a 17% sliver of the American people. Indeed, 14% of Americans--one out of every seven--believe it to be highly probable that they will lose health coverage under the GOP "plan." By a surprisingly wide margin--80%-14%--American voters opposed the senseless cut in federal funding for Planned Parenthood which is mandated by the "plan." And, by an equally surprising margin of 74%-22%, they opposed the draconian cuts that the "plan" would make to Medicaid--a lifeline, under the ACA, for millions of working-class and working-poor families.

If they did...

But, they don't.

It doesn't take more than a cursory look at this "plan" to understand that what Paul Ryan and Donald Trump and their fellow Republican hypocrites really care about is...

(1) Putting two of Paul Ryan's most hated "entitlement" programs--Medicaid and Medicare--on life-support. By block-granting capped Medicaid funds to the states, #TrumpRyanCare would hasten the end of Medicaid's expansive capacity to make health care coverage--including, by the way, nursing home stay--affordable and available to working-class and working-poor individuals and families. And the tax cuts provided for in the "plan" would, according to Brookings Institute economists, "exhaust the Medicare Trust fund by 2024."

My only surprise is that Ryan didn't go after the Social Security Trust Fund and the CHIP program as well. I mean, isn't it the American Way to put the elderly on ice flows and do all you can to block under-privileged children from entering the doors of a doctor's office?

(2) Making wealthy individuals even more wealthy and making one of our most profitable industries even more profitable.

After all, the only people who will realize any benefit from the increase in insurance premium costs, decrease in covered expenses and gobsmackingly huge tax cuts found in both #TrumpRyanCare are the insurance companies and those who breathe the rarefied air of the top 20%--and, most particularly, the top 1%.

Catherine Rampell, writing in the Washington Post, pointed out the obvious about Ryan's "replacement" for a repealed ACA: "...we should abandon the pretense. [The] Republicans' 'health care' bill is not really about health care...It's about hundreds of billions of dollars in tax cuts that will quietly pave the way for more, and far larger, tax cuts." These tax cuts, says the Joint Committee on Taxation, would amount to more than $600 billion over the next decade. And that doesn't include Ms. Rampell's "more, and far larger, tax cuts," which is a reference to the cuts found in #TrumpRyanTaxCuts that the GOP is apparently going to tackle in the near future. The total of both tax cuts could approach a $1,000,000,000 windfall for those Americans who need it the least.

Tax cuts of $1,000,000,000 over the next decade would, of course, result in another massive GOP redistribution of wealth upward, with 40% of their benefits going to the upper 1% and 2/3 of their benefits going to the top 20%.

And you thought Republicans wanted to repeal the ACA and institute their own plan because they were concerned about providing affordable, credible health care for all Americans?

What were you thinking?

Actuaries agree that the ACA is not in a "death spiral"--Politifact Wisconsin categorized Paul Ryan's claim that it is False. The CBO agrees with the actuarial reports. As does Forbes, which ran an analysis in March, 2016 entitled "Rumors of the Obamacare Death Spiral are Greatly Exaggerated."

Indeed, most health economists agree that it is relatively stable, this despite Republican attempts to sabotage it by (1) establishing a false narrative that it is "collapsing" and (2) stripping from it some of the elements that could have kept premium costs lower (though 80% of those who get their policies through the exchanges will see no rise in premiums because they receive subsidies that cover increases) and deductibles from rising--you will want to thank Marco Rubio for his work in sabotaging risk corridor funds.

What do we need?

A bipartisan effort to provide the "fixes" required by the ACA and to then offer the public option which President Obama wanted but which Republicans insisted be removed from the original bill. This would be a first step toward the only realistic way of insuring that all Americans have access to affordable health care--a single-payer system along the lines of "Medicare-for-all."

Every other nation in the developed world offers universal health care. What makes us different such that we couldn't?

Nothing.

Except the ideological obstructionism of the GOP and those parts of the health care industry--insurance companies, medical device companies, Big Pharma, CEO's of public and private non-profits--for whom lower health care costs mean smaller profits.