Let’s abandon the pretense.
Republicans’ “health care” bill is not really about health care. It’s not about improving access to health insurance, or reducing premiums, or making sure you get to keep your doctor if you like your doctor. And it’s certainly not about preventing people from dying in the streets.
Instead, it’s about hundreds of billions of dollars in tax cuts — tax cuts that will quietly pave the way for more, and far larger, tax cuts.
The American Health Care Act, which has been opposed by nearly every possible stakeholder of nearly every ideological orientation, is being rushed through Congress with non-extreme vetting. In fact, it passed out of one committee in the middle of the night, overseen by a committee chairman who just a day earlier criticized Obamacare for being “written in the dark of night.”
From the bill text, we can tell the directionality of some of the changes Republicans are proposing — i.e., tax revenue will fall, lots of people will lose health coverage and the Medicare trust fund will be exhausted sooner. But we still don’t know the magnitude of these changes — i.e., how much, how many or when, respectively.
We don’t know the answers to these questions yet, because Republicans don’t want us to know them. Part of the reason they have rushed the bill through committees is to front-run an (inevitably unflattering) analysis from the nonpartisan Congressional Budget Office.
In the meantime, other experts and government bodies have scrambled to compile their own estimates for the bill’s effects.
The ratings and analytics firm S&P Global has ballparked the number of people who would lose their insurance at 6 million to 10 million; others have offered figures as high as 15 million and 20 million. Meanwhile, a group of health researchers calculated that the bill would increase costs for enrollees on the individual insurance market by, on average, more than $1,500 per year when it would take effect, and by more than $2,400 per year by 2020.
Oh, and the Medicare trust fund would be exhausted by 2024, according to Brookings Institution researchers.
For those keeping score, that means fewer people would have insurance, those who get insurance on the exchanges would pay a higher price for it and Medicare’s solvency would be jeopardized as a bonus.
Hard to see how this achieves any of President Trump’s stated goals to “lower costs, expand choices, increase competition and ensure health-care access for all Americans.”
On the other hand, it’s quite easy to see how another well-established Republican goal would be achieved: tax cuts. Specifically, $600 billion of them, predominantly benefiting the rich.
The Joint Committee on Taxation has released a series of estimates showing what some of the tax-related provisions of Trumpcare would do.
Among the biggest are repeals of two ACA surtaxes on the highest-earning Americans: a 0.9 percent payroll tax add-on and a 3.8 percent tax on net investment income for couples whose incomes exceed $250,000 ($200,000 for individuals).
Repealing these would cost $275 billion over the next decade.
The law also axes other taxes, such as the tanning tax (once nicknamed the Snooki Tax, but now apparently a symbol of patriarchal oppression), and excise taxes on insurers; drug manufacturers and importers; and medical-device manufacturers and importers.
Based on what the Joint Committee has scored so far — and it has not analyzed every revenue loser in the bill — these tax cuts come to about $600 billion.
The presence of expensive tax cuts in a bill purportedly about health-care reform is not a side effect; it’s the entire point. They make it easier for Republicans’ (much bigger) individual and corporate tax cuts to sail through the Senate with minimal Democratic obstruction in a few months’ time.
Why? Under normal circumstances, Democrats would almost certainly filibuster the coming tax overhaul, preventing it from ever getting to a vote. But Republicans can take the filibuster option away by using the “reconciliation” process, which is an option if, and only if, the tax bill doesn’t increase government deficits in the long term, relative to existing law.
How do you keep tax cuts from increasing deficits relative to existing law? One useful tool is to change existing law — that is, to move the goalposts. Cutting taxes in the Obamacare repeal bill today lowers the revenue baseline against which a tax overhaul plan will be judged tomorrow.
So for those who have been scratching their heads about why Republican leadership is standing by a “health care” bill that does nothing to improve access to health care, remember: When you hear hoof beats, think tax cuts.
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