In January, when congressional Republicans huddled on Obamacare, now that they had to put up or shut up about the Affordable Care Act, the ever-blunt Rep. Tom McClintock, R-Elk Grove, cautioned his colleagues with an irrefutable fact.
“We had better be sure that we are prepared to live with the market being created,” McClintock said, unaware that the meeting was being secretly recorded.
“Republicans will own it, lock, stock and barrel,” he warned. And, he added, it would acquire a new name: “Trumpcare.”
Now the first draft of Trumpcare has been unveiled in all its dogmatic glory, and we are forced to wonder: Was anyone in that room at all listening to McClintock? Or to the thousands of voters who have packed town halls nationwide, demanding that Congress leave their health care alone if they can’t improve it, or at least, as the doctors say, first, do no harm?
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House Republican leaders claim their plan will keep Obamacare’s popular aspects – let parents keep children on their health insurance until age 26, and protect coverage for people with pre-existing conditions – but then they repeal the mandates and taxes that underpin them. And that’s just one terminal flaw among many in a plan that, whatever its intentions, would fleece middle-aged people, punish women, strand the poor and lavish tax cuts on the rich if passed in its current form.
House Majority Leader Kevin McCarthy, R-Bakersfield, who touted his party’s bill Tuesday, has been correct in noting that Obamacare needs fixing. People insured on private ACA exchanges have suffered from a shortage of doctors and watched in frustration as premiums rose.
But the Republican authors of Trumpcare seem to want to cure a cold with euthanasia. Their plan to gut the requirement that individuals carry insurance will almost certainly trigger a death spiral in which healthy people will opt out, causing premiums to soar for the sick who need insurance.
And the GOP fix there doesn’t make sense. Trumpcare would offer tax credits based on age and income as incentives to people to buy insurance if they can’t get insurance at work. But the young and working poor live paycheck to paycheck, not tax break to tax break. And for middle-aged workers, the credits appear to be utterly insufficient, at least for meaningful coverage.
Meanwhile, the Republicans would repeal the Obamacare mandate that insurance cover essential services, such as mental health care, hospitalization and pregnancy care. So under Trumpcare, policy holders could be ripped off more easily.
That potential loss of maternity benefits, by the way, would not be the end of the punishment for women on Trumpcare; the plan also defunds Planned Parenthood and outlaws the use of tax credits for the purchase of any private policy that covers abortion services.
And though Republican governors convinced them to hold off for two years – past the 2018 midterm election – Congress would end the Medicaid expansion that, in states such as California, insured millions of people.
After 2019, Trumpcare would force states to make do with small federal block grants capped at a rate that would grow far more slowly than the cost of health care. Thus, states would be left to decide which sick, suffering people to cover from a shrinking financial pot.
Trumpcare’s only apparent winners would be taxpayers with adjustable gross income of more than $200,000, who would get a hefty tax break. But it’s hard to be sure because, incredibly, the bill has been introduced without a Congressional Budget Office evaluation of its costs, fiscal and human. Clearly, the bill should not proceed without a CBO score.
Meanwhile, California health policy experts have been crunching their own numbers. Gerald Kominski, director of the UCLA Center for Health Policy Research, told The Sacramento Bee editorial board on Tuesday that, based on prior modeling, somewhere between 1 million and 3 million newly insured Californians would be expected to fall off the rolls here if this first draft of Trumpcare passes.
And in a couple of years, the state would be on the hook for an estimated $15 billion to $20 billion in Medi-Cal costs, annually. Those are heartbreaking numbers in this state, where uninsured rate stood at 7.1 percent at last count, down from 17 percent in 2013.
The plan has been slammed from the right as well as the left. Tea party conservatives have assailed it as “Obamacare Lite.” President Donald Trump praised it. Health and Human Services Secretary Tom Price called it a work in progress.
But is any of this what any politician wants to own, “lock, stock and barrel”? Polls show Obamacare is popular. Little wonder. Barack Obama’s signature domestic policy achievement has insured about 100,000 people in McCarthy’s Kern County district.
Ditto for Rep. Devin Nunes, R-Tulare. Rep. Doug LaMalfa, R-Richvale, has 128,000. Rep. Jeff Denham, R-Atwater, has 134,000. Rep. David Valadao, R-Hanford, has nearly 124,000. McClintock has 105,000.
Voters should remember these names, too, when they wonder who, in the name of dogma, decided to make America sick again.