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The Senate health care bill is proof: Trumpism isn’t populism

Senate Majority Leader Mitch McConnell (R-Ky.) unveiled the legislation that would reshape a big piece of the U.S. health-care system on Thursday, June 22. Here's what we know about the bill. (Video: Monica Akhtar/The Washington Post)

The Senate's health-care bill might be too much for even Marie Antoinette.

After all, about the only way it could be more regressive is if it took the cake a certain French queen wanted the poor to eat for dinner and gave it to the rich for dessert. Or, say, cut Medicaid and middle-class health insurance subsidies so much that 22 million fewer people have health insurance — all so that the government could afford to cut the capital gains tax for households making $250,000 or more.

Oh, wait. That last one is actually what the Senate bill would do.

It really is hard, as 538's Nate Silver put it, to think of anything less populist than the Republican health-care plan. You might be able to say the bank bailouts were, but even that's probably not true. As unfair as it was to give money to the people most responsible for the global financial crisis — and it was on a world-historical scale, especially when they were allowed to pay themselves that money in bonuses — it at least helped prevent what in all likelihood would have been an even bigger meltdown. The only thing worse than how much credit markets seized up before the $800 billion bailout is how much they would have if there hadn't been one. More people would have lost their jobs, loans would have become impossible to come by instead of just mostly so, and they would have stayed that way more than they already have, since it can take a while for new banks to replace the relationships and local knowledge that old ones had. That, at least, is what a professor named Ben Bernanke found was part of the reason the recovery from the Great Depression was as slow as it was.

The bailout, in other words, mostly helped Wall Street, but didn't exclusively help it. That's more than you can say for the GOP's health-care plan.

Now, there are three ways to think about the Senate bill. The first is that it would take health-care from the poor and middle-class to pay for tax cuts for the rich at a time of already historic inequality. The second is that it would make insurance more expensive for everyone and less useful for anyone who is sick. And the third is that it would hurt President Trump's working-class base the most. Other than that, how were the tax cuts, Mrs. Lincoln?

It's really pretty simple. The Senate bill would, over the course of the next decade, cut Obamacare's health insurance subsidies by $408 billion and Medicaid by $772 billion all to pay for $700 billion of tax cuts, nearly half of which the nonpartisan Tax Policy Center says would go to the top 1 percent of households. Not only that, but the fact that it would only peg the value of its remaining subsidies to higher-deductible plans means that a lot of people would be pushed into them. They couldn't afford anything else. On an apples-to-apples basis, the nonpartisan Kaiser Family Foundation estimates that the Senate bill would increase the cost of a “silver” plan that covers 70 percent of expected medical costs by an average of 74 percent over the next three years — and more for the type of older, poorer people who overwhelmingly went for Trump.

Although it's actually even worse than that. A 64-year-old making $26,500 would, according to the Congressional Budget Office, see their premiums for a silver plan go from $1,700 under Obamacare to $6,500 under the Senate bill — but it'd be for a silver plan that covered 17 percent less of their expected medical expenses. So they'd be paying more to get less. How much more? Well, the Kaiser Family Foundation calculates that, in the case of our hypothetical 64-year-old, their deductible would go from $809 to $6,105. And it'd be an even bigger jump for people a little bit lower on the income ladder. Someone making just $18,090 would see their deductibles increase from $255 to the same $6,105. The Senate bill, then, would leave a lot of people with a choice between plans they couldn't afford to buy and couldn't afford to use.

Or, as the Republicans would call it, freedom! And if you lived in a red state, you would probably get more of it. That's because the Senate bill would let them opt out of “essential health benefits” like mental health, maternity care and prescription drugs — and in the process, the Brookings Institution's Matthew Fiedler points out, bring back annual and lifetime limits on benefits. The result would be a system where healthy people would mostly buy cheaper plans that didn't cover much, and mostly sick people would buy ones that did, you know, cover things — which would only make those more comprehensive plans so expensive that hardly anybody would be able to buy them at all. People would be forced to buy skimpy insurance that might not even insure you if you use too much of it.

This isn't a health-care plan that helps you if you need health care. Not when it would give you higher premiums, higher deductibles and worse coverage. No, this is a health-care plan that only helps you if you're wealthy and have a lot of investment income. It would cut the tax on capital gains, interest and dividends from 23.8 to 20 percent for households making $250,000 or more. Other than that, you're out of luck — and maybe out of being insured. Indeed, the CBO estimates that the Senate bill's $1.1 trillion of cuts to health insurance spending would result in 22 million fewer people having insurance in 10 years' time. All so that the top 2 percent of households, who are the only ones really getting ahead in today's economy, can have 2 percent more money after taxes.

Let them pay a third of their income in deductibles is the new “Let them eat cake.”