(Cliff Owen/Associated Press)
Opinion writer


The single most glaring feature of the Republican health-care plan is how massively regressive it is. Whether in the Senate or House version, it cuts health-care spending on poor people by hundreds of billions of dollars, to finance (relative to current law) an enormous tax cut for the rich. The regressiveness of the plan is a feature, not a bug. Even if you allow that Republicans believe in a principled way that this will benefit America, it is the plan’s overriding ideological goal. Cutting spending on the poor to facilitate a huge tax cut for the rich, in many ways, is the plan.

But what if a large majority of Americans don’t have a clear sense that the plan even does this? A new Kaiser Family Foundation poll out today suggests this may be the case, which hints at a number of troubling things about where this debate is headed next.

The Kaiser poll finds that only 38 percent of Americans know that the GOP plan makes “major reductions” in Medicaid spending. Another 27 percent say it makes “minor” reductions; 13 percent say it makes no reductions; and 20 percent say they don’t know. If this polling is right, that means at least 6 in 10 Americans are unaware of the central feature of the GOP plan to reconfigure one-sixth of the U.S. economy, one that will impact many millions of people over time.

At the same time, though, the poll finds that the public broadly approves of Medicaid as it is and supports continued spending on it — and that very few Americans support the GOP cuts when asked. Sixty-one percent of Americans say that Medicaid is “working well” for most low-income people it covers. But only 36 percent support cutting funding for Obamacare’s Medicaid expansion; and only 35 percent support changing Medicaid’s funding to limit how much states get each year. The GOP plan phases out the Medicaid expansion and uses per-capita caps to limit payments to states, in what could shape up as a dramatic overhaul of Medicaid well beyond ending the expansion, resulting in deep cuts to the program’s assistance to poor children, people with disabilities and the sick.

As it is, the Kaiser poll finds that only 35 percent approve of the GOP plan, which is actually better than other polls. It’s hard to explain the disapproval of the plan in light of public unawareness of its key features. Maybe it’s “status quo bias,” reflexive opposition to change. Maybe it’s all the headlines saying 23 million will lose coverage — perhaps the public has a vague sense that this would be the outcome, without knowing specifically how. Regardless, if more Americans fully grasped the plan’s enormous Medicaid cuts, disapproval might be even deeper.

All of this suggests that in some key ways, the GOP strategy is working. Republicans have gone to enormous lengths to obscure the plan’s profoundly regressive features. They have endlessly told the lie that no one will be worse off (because everyone will have “access” to affordable coverage), and they’ve developed numerous cleverly designed talking points designed to create the impression that, by slowly phasing in the loss of coverage for millions over time, this will create a painless transition to … well, to a blissful state in which everyone, again, has “access” to affordable coverage. Among these: “Smooth glide path.” “Rescue mission.” “Bridge to better health care.” “Soft landing.”

But it’s important to understand that this scam has multiple layers. The slow phase in isn’t merely about creating the impression of a painless transition. It’s also about deferring accountability. This is particularly the case with the Senate version of the bill, which must appear softer than the House bill in order to get the support of key Republican moderates who represent states with large Medicaid expansion populations. Nicholas Bagley, a health policy expert at the University of Michigan, emails me:

The Senate bill front-loads the sweet stuff and delays all the painful stuff. The tax cuts kick in immediately; so too does relief from the individual mandate. But the bill holds off on slashing Obamacare subsidies until 2020, well after the next round of congressional elections. And it delays the Medicaid cuts until 2021, right after the next presidential election. So, by design, the law aims to allow Republicans to duck political accountability for taking insurance away from people.

The strategy is even more devious than this, however. The Senate bill phases in the Medicaid cuts more slowly than the House bill over time, to allow moderates to argue it is softer. But it uses a harsher funding formula in order to cut the program at least as deeply later. As the Kaiser Family Foundation’s Larry Levitt has explained, the basic overriding truth here is that, because the Senate bill keeps the House bill’s enormous tax cuts for the rich, it must cut spending on health care for the poor by similarly large amounts; all it can do is move those cuts around. And that’s exactly what the Senate bill does. It’s a cruel and cynical shell game.

There is no telling what will happen to the millions and millions of poor people who can’t get coverage in the next decade. Right know, though, large majorities may not even know that the plan Republicans are trying to pass even would bring this about. And when the cuts do phase in, many won’t even remember this vote, perhaps leaving any hope of accountability far back in the past.

* TRUMP AGAIN HINTS AT TRYING TO REMOVE MUELLER: Trump told “Fox and Friends” in an interview that he views the friendship between former FBI director James B. Comey and special counsel Robert S. Mueller III as “very bothersome.” And:

Asked whether special counsel Robert Mueller should step down because of his friendship with Comey, Trump said, “We’re going to have to see.”

Just in case you thought the possibility that Trump would still try to remove Muller had been ruled out.

* DOES McCONNELL WANT HEALTH BILL TO FAIL? The New York Times floats the possibility that Senate Majority Leader Mitch McConnell (R-Ky.) may actually prefer it if the Senate health bill fails, and vulnerable GOP senators avoid voting for it:

Mr. McConnell has always taken pride in protecting his members. Trying to come to a meeting of the minds with the House — which crafted a far more conservative bill in many respects — would be time-consuming and unpleasant. Mr. McConnell and many of his aides are also eager to get to the business of changing the tax code … For Mr. McConnell, cutting taxes is a much higher priority than health care, which time and President Trump have turned into quicksand for him and his fellow Republicans.

The process of merging the Senate and House bills could take weeks, exposing vulnerable members to a sustained barrage of additional attacks, including over the August recess.

* WHY GOP GOVERNORS SHOULD HATE THE SENATE BILL: Drew Altman, president of the Kaiser Family Foundation, explains why the Senate bill’s deep cuts to Medicaid and system of per-capita caps will be so destructive:

The Senate plan imposes a harsher formula for its cap than the House plan, which already cuts Medicaid spending by $834 billion over 10 years. Because states have to balance their budgets every year, unlike the federal government, many will struggle to compensate for reductions in federal aid caused by a spending cap. Many states will be forced to choose between Medicaid and other priorities, like education, law enforcement and prisons. The inevitable result will be a reduction in health care spending on low-income people.

This is what the conservative mantra of “more flexibility to the states” really means.

* TRUMP PREDICTS CONSERVATIVES WILL BACK BILL: Four conservative senators — Ron Johnson of Wisconsin, Mike Lee of Utah, Rand Paul of Kentucky and Ted Cruz of Texas — say they can’t back the Senate bill in his current form. Trump says he’s not worried:

In an interview with Fox News Channel, Trump was asked about the four conservatives opposing the bill. “Well, they’re also four good guys, four friends of mine and I think that they’ll probably get there,” he said. “We’ll have to see.”

I think they very well may get there, too, but not because they are “good guys.” Still, the hint at doubt is noteworthy.

* INSIDE RUSSIAN SABOTAGE OF ELECTION: The Post has a deep dive into the Obama administration’s efforts to counter Russian efforts to undermine the election. This meeting among congressional leaders is notable:

The meeting devolved into a partisan squabble. “The Dems were, ‘Hey, we have to tell the public,’ ” recalled one participant. But Republicans resisted, arguing that to warn the public that the election was under attack would further Russia’s aim of sapping confidence in the system … McConnell went further, officials said, voicing skepticism that the underlying intelligence truly supported the White House’s claims.

The article includes Democrats also faulting the Obama administration’s tentative response, so no one is blameless. But one side took the matter far more seriously than the other.

* TRUMP RAGES AT WHITE HOUSE COUNSEL: Politico reports that Trump erupted with anger at White House counsel Don McGahn, per four people familiar with the conversation:

Trump started the week by giving McGahn … a dressing down in the Oval Office for not doing more to squash the Russia probe early on. Trump’s willingness to lay into him for the escalation of the probe — largely the result of Trump’s own decision to dismiss Comey — illustrates McGahn’s falling stock in the West Wing, as well as Trump’s desire to find someone to blame for his legal predicament.

Recall: Trump fired James Comey in part because he didn’t make the Russia probe disappear, and that led to the probe expanding, which he is now blaming on others who also didn’t make it disappear.

* AND TRUMP BASKS IN HIS OWN APPLAUSE: Trump today tweeted that he had signed 38 bills, adding: “Nice!” NPR’s Tamara Keith sets the record straight:

Measuring laws passed by counting rather than by significance is pretty meaningless … But by way of recent historical comparison, Presidents Jimmy Carter (52), George H.W. Bush (41) and Clinton (41) had all signed more bills into law than President Trump by this point in their presidencies. So, what has Trump accomplished with congress so far? Nothing that political scientists would categorize as major pieces of legislation.

As Keith notes, 15 of these repeal Obama-era regulations, six modify existing programs, and most of the rest encourage an agency to try something new or name something.