Sen. Mitch McConnell has called off a vote this week on the Senate Republican health-care bill. That’s a good thing. Because if Republicans want to confirm every liberal caricature of conservatism in a single piece of legislation, they could do no better than vote on the GOP bill in its current form.
Here is the summary of the bill that Democrats will take to the American people in 2018: Republicans voted to cut $701 billion in taxes for corporations and the wealthy, and pay for it with $772 billion taken from Medicaid for the poor — all while pushing 22 million Americans off health care.
And Senate Republicans are writing the script for them. Have they lost their minds?
Let’s be clear: The investment tax and Medicare surcharge in Obamacare are a drag on economic growth. But if Republicans want to eliminate them, they should do so as part of broader tax reform and pay for it with other changes in the tax code — anything but Medicaid cuts for the poor. Paying for a massive tax cut for the wealthy with cuts to health care for the most vulnerable Americans is morally reprehensible.
It is also politically suicidal. If Republicans bring this bill to the floor, under reconciliation rules (which allow the GOP to pass the bill by a simple majority) there will up to 20 hours of debate and unlimited amendments. Senate Democrats will force Republicans to cast one vote after another designed to make them look like monsters come Election Day. They will make Republicans vote “no” on eliminating tax cuts for the rich and using that money for opioid treatment, services for the disabled, nursing home residents, children’s health — you name it.
Even better for Democrats, the bill will disproportionately impact states President Trump won which are the epicenter of the opioid crisis. According to one Harvard University/New York University estimate, about 1 million people are receiving substance abuse and mental-health treatment under the Medicaid expansion — with more than 400,000 in just two states Trump won, Ohio and Pennsylvania. Other states heavily impacted included Alaska, Arizona, Maine, Nevada, Tennessee and West Virginia. Nationally, spending on substance abuse treatment in the Medicaid expansion population is estimated to be $4.5 billion per year. The GOP bill includes a measly $2 billion for opioid treatment in 2018. That’s chump change.
Conservatives are right to reform Medicaid. There is nothing wrong with entitlement reform that moves to a per capita cap system, so long as the caps are designed to rise with the costs of medical inflation (which they don’t in the Senate bill). But the savings need to be used to help people get coverage on the private market — not used for tax cuts for the wealthy. Conservatives should not trap people in poverty because the only way they can get adequate health care — including appropriate help for substance abuse and mental health — is through Medicaid. According to the Congressional Budget Office, the increase in out-of-pocket costs in the Senate bill would contribute “significantly” to a reduction in the number of lower-income people who obtain coverage. Even if they are eligible for premium tax credits, as a result of the high deductibles few low-income people would purchase any plan. That is unacceptable.
It’s also politically insane for the GOP to pass a bill that will reduce the number of Americans with health coverage by 22 million. Our goal should be to expand the number of Americans buying health coverage, not reduce it. And there are good, conservative ways to do so. My American Enterprise Institute colleague Jim Capretta and Hoover Institution fellow Lanhee Chen have designed a plan to automatically enroll Americans who don’t get health insurance from their employers in high-deductible catastrophic care policies whose premiums equal the value of the federal tax credits. This would not be a mandate — they could withdraw from the plans if they wanted to. In this way, we could get virtually every American — including the young and healthy — into the insurance market, which would reduce costs for older and sicker Americans. This way, instead of fending off Democratic criticism for driving millions of Americans off their health plans, Republicans could claim credit for bringing the country closer to universal health coverage. Sens. Bill Cassidy (R-La.) and Susan Collins (R-Maine) have adopted this approach in their alternative plan.
But instead of expanding coverage, Republicans seem intent on painting themselves as reverse Robin Hoods, who steal from the poor to give to the rich. That is not what Trump promised when he talked of a bill with a “heart.”
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