Health care, mean-style

Plenty of good takes out there on the Senate bill.  Some highlights from some I enjoyed the most:

Ezra, “The Senate GOP health bill in one sentence: poor people pay more for worse insurance,”

There are a lot of moving parts in the health bill Senate Republicans just released, but the bigger picture is straightforward. Health care expert Larry Levitt condensed it to fewer than 140 characters:

That’s it. That’s what this bill does. In fact, it does it over and over again. Policy after policy in the bill is built to achieve the same goal: making poor people pay more for less health insurance. [emphasis mine]

Ezra, again, “The Senate health bill takes what Americans hate about Obamacare and makes it worse”

The Senate GOP’s health care bill is a strange document. It doesn’t fix what conservatives dislike most about Obamacare. But it takes what everyone else hates about Obamacare and makes it much, much worse.

The plan keeps Obamacare’s basic structure intact. The tax credits remain tied to income. Many of the insurance regulations remain in place. Medicaid is, in theory, gutted down the road, but the cuts don’t even begin until 2021 — raising the fear for conservatives that they’ll never happen at all. Even the cost-sharing reductions to insurers — which Republicans bemoaned as an illegal “bailout” — are restored.

So Obamacare — the government program that makes it the state’s responsibility to cover people with health insurance — mostly survives. If you are a conservative angry that the federal government has created a new health care entitlement, this bill doesn’t solve your problem.

But under the Senate bill, Obamacare’s ability to actually cover people with health insurance is sharply diminished. Because the plan shifts hundreds of billions of dollars in insurance subsidies to tax cuts for the wealthy, there’s not enough money in it to cover nearly as many people, with nearly as good insurance, as there is now.

Atul Gawande, “there will be deaths.”

Sarah Kliff on why Republicans are supporting such unpopular legislation:

So why do Republicans keep persisting with their health care bill? I attended a breakfast with a Republican member of Congress this morning who gave a pretty frank answer. They are moving forward with Obamacare repeal because they believe their base will stick with them and that they don’t need to pay too much attention to the protesters, this member of Congress said. Here’s how this person thought about the recent barrage of calls his office has received:

The way I look at is there is no question we’re getting inundated with calls and emails and protests. There is all this energy and anger on the left. The people who lost are the ones who are angry. We won the entire elected government. So I remind my staff after a long day of hostile calls, it was less than six months we got more votes than a person on the other side in [my state]. The people who voted for me are still out there.

Jamelle Bouie tackles the same question.  Short version: because they can:

As a general matter, lawmakers don’t pass hugely unpopular legislation that might harm constituents in such a direct way. It’s easy to say that, for House and Senate Republicans, their “constituents” are those wealthy Americans who receive huge tax cuts under the bill. Still, it’s also true that winning donors isn’t the same as winning elections. Politicians don’t need to value the public interest to reject a bill like the AHCA; a survival instinct should be enough…

At most, it exists to fulfill a promise to “repeal Obamacare” and cut taxes.

Perhaps that’s enough to explain the zeal to pass the bill. Republicans made a promise, and there are forces within the party—from hyperideological lawmakers and conservative activists to right-wing media and Republican base voters—pushing them toward this conclusion. When coupled with the broad Republican hostility to downward redistribution and the similarly broad commitment to tax cuts, it makes sense that the GOP would continue to pursue this bill despite the likely consequences.

But ultimately it’s not clear the party believes it would face those consequences. The 2018 House map still favors Republicans, and the party is defending far fewer Senate seats than Democrats. Aggressively gerrymandered districts provide another layer of defense, as does voter suppression, and the avalanche of spending from outside groups. Americans might be hurt and outraged by the effects of the AHCA, but those barriers blunt the electoral impact.

The grounds for political combat seem to have changed as well. If recent special elections are any indication—where GOP candidates refused to comment on signature GOP policies—extreme polarization means Republicans can mobilize supporters without being forced to talk about or account for their actual actions. Identity, for many voters, matters more than their pocketbooks. Republicans simply need to signal their disdain—even hatred—for their opponents, political or otherwise. Why worry about the consequences of your policies when you can preclude defeat by changing the ground rules of elections, spending vast sums, and stoking cultural resentment? [emphasis mine]

Also, the Medicaid cuts are particularly wrong-headed and cruel.  More on those later.


About Steve Greene
Professor of Political Science at NC State

One Response to Health care, mean-style

  1. Nicole K says:

    My dad suggested that the Republicans in congress would benefit from studying Micah 6:8:

    He has shown you, O mortal, what is good.
    And what does the Lord require of you?
    To act justly and to love mercy
    and to walk humbly with your God

    Justice and mercy are clearly not the motivation behind the effort to ruin health care.

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